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Discover more value at
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COVER

P. 42

AHLMAGAZINE.COM

Cover and this photo: Kristin Deitrich

Eli Lillyâ&#x20AC;&#x2122;s Sonia Chen Arnold
changed career paths from
music to law to chase her
passion for helping others.

3

CONTENTS

American Healthcare Leader
APR.MAY.JUN 2017

P. 8
Facility Spotlight
P. 174
The Vitals

Life

P. 177
People & companies
index
P. 178
Stat Sheet

P. 54

AHL APR.MAY.JUN 2017

Itâ&#x20AC;&#x2122;s been a decades-long journey, but Hollywood
Presbyterian Medical Centerâ&#x20AC;&#x2122;s Janice Klostermeier has
made it to the C-suite, and now she reflects on the path
she took and the challenges women face along the way

4

P. 18
Trent Taher seeks to end mystery meat with healthier
and tastier school lunch options

One of the most common insights I hear from the individuals we feature
is something to the effect of, “the only constant is change.” At AHL, we
aim to bring you the stories of leaders who are not only enacting change
in how they provide care, but also those who followed different, unorthodox paths into leadership. For some, change had been a recurring theme
long before they stepped into the field of healthcare.
“If I hadn’t taken risks and embraced opportunities to lead, I wouldn’t
be where I am today,” says Sonia Arnold, the subject of our latest cover
story (p. 42). It sounds obvious, but Arnold isn’t talking about your runof-the-mill, steady capitalizations up the rungs of one ladder. Arnold has
jumped across several ladders on her way up.
As a violin student at Vanderbilt University, Arnold thought that she
was on her way to being a full-time musician, until a mentor inadvertently dissuaded her with one sentence: “The only people who should
be musicians are those who can’t live without it.” That initiated a series
of pivots: into music publishing, then into studying entertainment law
at Indiana University, then private practice, and ultimately, her current
position as assistant general counsel at Eli Lilly.
Had she viewed each of these changes as a setback, Arnold might have
exhausted herself before getting the chance to answer her true calling.
Instead, she kept the faith that progress isn’t always a straight line; as
she stresses to her mentees today, “[Don’t] be so focused on what you
‘should’ do.” In other words, real opportunity is often at odds with opportunism. Trying on different passions
and interests, inconvenient as they
may be from a careerist standpoint,
cultivates a sense of your best self,
which will lead to your best work.
Today, Arnold gives back to all the
different cultures that helped her on
her way up, serving on boards for the
International Violin Competition of
Indianapolis, Indiana University’s
Lilly Family School of Philanthropy,
and the Asian American Alliance.
They’re all a part of her, just as
we’re all products of our past experiences—something that we kept in
mind as we produced the stories of
everyone in these pages, and we hope
you will, too.

Client Services Director
Cheyenne Eiswald

VP of Sales
Kyle Evangelista

Senior Client Services
Manager
Rebekah Pappas

Director of Sales Operations
Philip Taylor

Client Services Manager
Katie Richards

Managing Director
Kim Harrington

Financial Analyst
Mokena Trigueros

Content and Advertising
Managers
Megan Apfelbach

Junior Analyst
Amanda Paul

Steven Arroyo
Editor

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For a free subscription, please visit ahlmagazine.com.
Printed in China. Reprinting of articles is prohibited without
permission of Guerrero Howe, LLC. For reprint information,
contact Stacy Kraft at 312.256.8460 or stacy@guerrerohowe.
com. AHL Magazine® is a registered trademark of Guerrero
Howe, LLC.

Kristin Deitrich

AHL APR.MAY.JUN 2017

SALES & ACCOUNT
MANAGEMENT

PUBLISHING

Changing Courses

Big ideas
can come
from
anywhere.

Keeping You Ahead of the Curve
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Liberty Fox is a fast-growing technology consulting firm conducting business in
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Planned Parenthood Queens:
Diane L. Max Health Center
Queensâ&#x20AC;&#x2122;s first Planned Parenthood center
opened in September 2015, giving the
reproductive health nonprofit a location
in every New York City borough.

AHL APR.MAY.JUN 2017

Photos by Michael Moran / OTTO

8

The space was
designed to
make visitors
feel welcome,
but protected.

FACILITY SPOTLIGHT

Stephen Yablon
Architecture
converted the
two-story center
out of a former
lumberyard
facility.

Bold colors and
natural light
brighten simple,
open floor plans.

AHLMAGAZINE.COM

9

“Kids recognize
repetition. If they
keep seeing the
same fifteen items,
they say, ‘What
are you going to
show me that I
haven’t seen yet?’”
P. 18

PULSE

PULSE

BRENNAN
TORREGROSSA
VP, Associate
General Counsel
GlaxoSmithKline

The Move to Kill
the Billable Hour
12

By Bridgett Novak

Rebecca Henasey

AHL APR.MAY.JUN 2017

The tide of legal billing processes in pharmaceuticals is turning toward value-based systems,
according to Brennan Torregrossa, VP and associate general counsel for GlaxoSmithKline

PULSE

tional request for proposal. Torregrossa describes it as a “reverse
eBay process.”
“The firms can’t see who they
are bidding against, but they can
AFA ACCLAIM
see the bids and where they rank,
which usually inspires them to
GlaxoSmithKline's alternative fee
lower the cost of their proposal,”
arrangements and use of the Outside
Torregrossa says. Price is not the
Counsel Selection Initiative was
only factor on which GSK bases
named a Value Challenge award
its decision, though. “Our manwinner in 2012 by the Association
aging attorneys assign scores to
of Corporate Counsel. As the judges
various aspects of the propossaid, “The clear objective to move all
als—e.g., the law firm’s expertise
of GSK's legal work to value-based
in a legal area and jurisdiction,
fee arrangements and the use of
key impressions of how they
technology and a scorecard to select
would handle the case or project,
outside counsel are novel and have
the diversity of their team. All
led to substantial cost savings.”
those things are factored into an
overall score for each firm. Our
goal is to get the right lawyer or
law firm for the right case at the
right price.”
Torregrossa realizes that this is a direct challenge to
the way most law firms operate, with annual increases in
salaries, billable rates, and hourly quotas. “The pressure
to bill an incredible number of hours is, well, incredible.
I want to lift that weight off lawyers. I want to get back to
building some results together and want our outside law
firms to have that same commitment,” he says.
“When Don Draper in Mad Men worried about accountants wielding too much influence in the company, he
asked, ‘What are we doing here? Why are we spending so
much time trying to turn a dollar into a dollar [and] ten
[cents]? Who’s in charge?’ That’s how the billable hour
can make you feel,” Torregrossa continues.

“We want to reward outside
counsel for the work they
do, not for the hours spent
doing it.”

AHLMAGAZINE.COM

Brennan Torregrossa loves a challenge.
“I enjoy trying things that have never
been tried before. Just because something is easy or ‘the way it’s always been
done’ doesn’t mean it’s right,” he says.
As vice president and associate general counsel in
charge of GlaxoSmithKline’s (GSK) Global External
Legal Relations Team (GELRT), Torregrossa’s mandate
is to redefine the way the pharmaceutical giant pays its
outside law firms. “To put it simply, we’re trying to kill
the billable hour. But it’s really more nuanced than that.
We’re trying to establish win-win relationships, obtain
excellent legal representation, and work with firms
that deliver great value and are willing to work with us
outside the billable hour model,” he says.
They’re not alone in this effort. According to Altman
Weil’s 2015 Law Firms in Transition survey, 93 percent
of law firms in the United States offer some type of
alternative fee arrangement (AFA) or value-based fee
arrangement (VBF), and 81 percent of lawyers believe
non-hourly billing has become a permanent trend in the
profession. These numbers make the practice appear
more widespread than it really is, though. While the
number of corporate legal departments experimenting
with AFAs has increased, the overall amount of work
being done on a non-hourly basis has remained steady
the past several years at just 9 percent, according to the
Enterprise Legal Management Trends Report.
While the trend is evident—and had received a major
spark following the 2007–2008 recession—GSK’s dedication to the goal is revolutionary. In 2008, when GSK’s
general counsel, Daniel Troy, asked Torregrossa’s predecessor Bob Harchut to implement the plan, 97 percent
of the company’s legal work was paid by the hour. Today,
it is just 15 percent.
“When you pay by the hour, you pay for the time, not
the service, which can lead to lots of inefficiency,” he
explains. “We want to reward outside counsel for the
work they do, not for the hours spent doing it.” To make
this viable, GSK has broken its legal work into tasks,
describing the desired results rather than the duration.
But how does Torregrossa’s team know how to price
various legal tasks? He admits it has been, and continues to be, a learning process. One of the solutions they’ve
hit upon is an online bidding program called the Outside
Counsel Selection Initiative (OCSI). Launched in 2010,
the program, which was borrowed from GSK’s procurement department, invites certain law firms to submit
proposals for specific matters, quite similar to a tradi-

13

PULSE

OCSI BY THE NUMBERS

$5,000,000

GlaxoSmithKline tracked the
results of six recent cases
where it hired outside firms
for counsel on a flat-fee
bidding basis, finding that
each resulted in dramatic
savings compared to its
original budget as a result.

This approach has been well-received by his colleagues:
“We appreciate Brennan’s approach to his new role.
Success in this model requires an open dialogue with the
inhouse and law firm lawyers, and it does require adjustment over time," Gordon Cooney of Morgan Lewis notes.
“We believe that we can all benefit from a model that
rewards efficiency and successful outcomes.” GSK has
reduced its legal spending by roughly 20 percent since
switching from the billable hour to mostly fixed or flat
fees, but Torregrossa says the payoff doesn’t stop there.
“It’s never been just about saving a dollar because we
can, but because we should. We believe this allows us
to better align our interests with those of our law firms.
And every dollar we save on legal fees can be returned
to shareholders, spent on research and development
to discover important new vaccines or other drugs, or
used to help lower the cost of our consumer products,”
he explains.
The switch has also enabled GSK to reduce inefficiency in-house. Where they used to spend an abundance
of time reviewing law firm bills, checking hours, and
keeping an eye out for budget overruns, GSK’s attorneys
now receive quarterly reports from the law firms they’re
working with and will soon use dashboards to track the
status of their projects.
But have any of their go-to firms declined to make the
switch? “Certain firms have more of a challenge to play in
this environment than others, but most firms know that
the tide has turned and clients are demanding flexibility
in the way they pay for matters,” he says.

Revised Initial Offer

Final Offer

“The companies leading this
revolution away from the
billable hour have one thing
in common: general counsel
who make the mission an
absolute priority.”

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15

PULSE

And what about those lawyers
who can charge whatever they
want? “Some lawyers have an
extraordinary amount of cachet in
certain areas of law, enabling them
to set their own rates,” he says. “It’s
hard to push against that if the
market is willing to pay it. But even
some of those attorneys have been
willing to try a new model.”
Torregrossa says that companies that wish to make task-based
billing work must have clear direction from the top: “The companies
leading this revolution away from
the billable hour have one thing in
common: general counsel who make
the mission an absolute priority.”
“I believe this is a far better way
to pay for legal services,” he says. “It
can be exhausting fighting against
something as ingrained as the billable hour, but we now feel there is
more of a match between what we’re
paying and the value we’re getting.
It is all about building strong relationships with firms we trust to
represent us and who trust us to
compensate them fairly.” AHL

Phillips Lytle congratulates Brennan Torregrossa for
the recognition of his commitment, creative vision
and strong leadership.

AHL APR.MAY.JUN 2017

We appreciate firsthand the environment of
collaboration he fosters in his client-attorney
relationships.

King & Spalding is an international law firm
that represents a broad array of clients, including half of the Fortune Global 100. With more
than 900 lawyers in eighteen offices around the
world, King & Spalding was recently chosen by
Law 360 as the "Law Firm of the Year" for product liability and LMG Life Sciences selected the
firm as one of the finalists for “Regulatory Firm
of the Year” in 2015. www.kslaw.com
Morgan Lewis offers life sciences and healthcare companies sophisticated, integrated, and
cost-effective counsel covering all of their
unique needs. We advise clients on litigation and
dispute resolution; business transactions and
joint ventures; US federal, state, and local regulation; coverage and reimbursement; fraud and
abuse; and compliance. We also counsel life sciences and healthcare companies on intellectual
property, antitrust, public policy advocacy, real
estate, and labor and employment issues.
Shook, Hardy & Bacon is nationally recognized
as a preeminent firm for complex litigation,
particularly in science, medicine, and technology. Shook has represented dozens of pharmaceutical clients, including each of the top ten
pharmaceutical companies worldwide—Bayer,
GlaxoSmithKline, Johnson & Johnson, Pfizer, and
Sanofi, among them. Shook’s Pharmaceutical
and Medical Device Team partners with companies to navigate complex operational, technological, and regulatory challenges, manage emerging threats, and overcome potential obstacles.

King &
Spalding joins
in honoring
the great work
of our friend
Brennan
Torregrossa,
GlaxoSmithKlineâ&#x20AC;&#x2122;s Vice
President
and Associate
General
Counsel.
Congratulations
on your
continued success.

AHLMAGAZINE.COM

www.kslaw.com

17

PULSE

Out of the Deep Fryer
Trent Taher brings nutritious, creative cuisine to school cafeterias

AHL APR.MAY.JUN 2017

By David Baez

18

As time goes by, the old stereotypes
surrounding school cafeteria food continue to dwindle. While those who came
of age decades ago will surely recall the
iconic lunch lady dishing out such standbys as sloppy joes, grilled cheese sandwiches, and tater
tots, there are some students today who sit down with a
spectrum of nutritional foods that could, if Taher, Inc.
is the vendor, include pork belly ramen, fresh slices of
mango, and yucca, a South American tuber.
This notion isn’t new. It started to gain traction back
when Trent Taher’s father, Bruce, founded the food
service company in 1981. It was then that the company
began focusing on health, an initiative that was set in
place well before the wave of nutrition consciousness
hit—especially after former First Lady Michelle Obama’s
changes to the requirements in the federal government’s
National School Lunch Program (NSLP) in 2012. The
NSLP is a longstanding program through which the government subsidizes the cost of food for schools, so they
can sell it at reduced or no cost to low-income students.
Today, Taher serves as director of wellness, nutrition,
and culinary development for the company, where he is
in charge of developing the menus and working with
on-staff nutritionists to green-light every ingredient

that goes into the recipes. When working with production partners, Taher checks ingredients against a long
list of banned items, including certain artificial colors,
artificial sweeteners, high fructose corn syrup, and partially hydrogenated oil. If a food contains any of these
ingredients or others on the list, Taher won’t accept it.
Meat has to be free of antibiotics and hormones as well.
At the same time, Taher also works with a list of artificial ingredients that are considered less harmful and
acceptable in the short-term, but still result in being
flagged. The offending ingredients are then replaced as
soon as possible. The company’s nutritional policies fall
under the umbrella of their Food4Life initiative. Not only
does Taher make sure to meet the requirements of the
NSLP—which postdates the company’s initiative—but
it continues to push the envelope. Case in point: in 2008,
the company voluntarily ceased using all foods with trans
fats not only for school lunches, but also for the corporate clients they serve. As Taher explains, making all this
happen often requires educating the company’s manufacturing partners.
“As the NSLP has taken off, producers and manufacturers are more versed in what the requirements are and
are catching up,” Taher says. “But we always meet with
producers about what they need to change in the project.

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“We are constantly finding ways
to make what we have healthier
and cleaner.”

One group was trying to sell us a packaged snack, but it
contained red dye. I told the CEO that they were standing
outside of our Food4Life initiatives and that we’d have to
flag it. A month later, he told me that based on our conversation, they had changed their formula and also pulled
corn syrup.”
As part of the changes to the NSLP in 2012, every
two years in some states or every three in others, any
school that is being funded by the program has to open
up the bidding process to other vendors. In many cases,
the current operator will put in a bid, and quite often,
other vendors will choose to bid against it. In one such
case, Taher was ousted by the lowest bidding vendor.
But a few months into the school year, the community
was disappointed with the new company’s products and
Taher returned.
“You have districts that look at the school lunch
program as a profit center,” he explains. “A portion of the
sales that come from the lunch and breakfast program
are commissions you pay to the school; the percentage is
determined in the bidding process. Schools badly in need
of money use these programs to generate income. Others
are more focused on being healthy and clean. Those are
the ones we prefer to work with. We thrive when we find
ourselves in a community that wants healthy, diverse
food, and the school administration is on board as well.”
This can tend to lead to contracts with private and
charter schools, though the company still works with a
greater number of public schools. The ones the company
avoids are the ones deemed to be mired in the “race to
the bottom”—those looking for the cheapest execution
possible to increase their bottom line.
In addition to the health focus, Taher spends an abundance of time and energy diversifying its menus through

Last fall, Trent
Taher joined his
father, Bruce (right),
in addressing the
crowd during a
Farm Dinner in
Wisconsin, where
they prepared a
five-course dinner.

20

Taher gets
ready to grill
an entire
pork flank, or
matambre,
as part of
a reception
dinner last
fall.

Ilisa Ailts

AHL APR.MAY.JUN 2017

“Whether it’s internationally
driven, or from menu teams I
work with here, we’re always
coming up with new things.”

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its Chef’s Council. The program was started about fifteen
years ago to explore new geographical areas and find
new foods. They started with trips to major cities in the
United States, such as New York and San Francisco, and
then began taking international trips. The group has gone
on discovery missions to a variety of countries, including
India, Italy, Israel, Vietnam, South Korea, Japan, Peru,
Argentina, and Turkey.
Taher says that the international trips are considered
a corporate expense under innovation. Variety comes in
a close second to health considerations in the company’s hierarchy. For the upcoming school year, Taher will
launch more than twenty new menu items. “Whether
it’s internationally driven or from menu teams I work
with here, we’re always coming up with new things,” he
says. “Kids recognize repetition. If they keep seeing the
same fifteen items, they see the pattern and basically say,
‘What are you going to show me that I haven’t seen yet?’
We have to introduce new items throughout the year so
it doesn’t become repetitive.”
Each month, the company features a different fruit or
vegetable, a different grain or legume, and an alternate
herb as part of the Harvest of the Month program. In any
given month, the Taher team will prepare a meal that
mixes them all together, such as mango with cilantro. The
company will also put up fliers in the school touting the
health benefits of the featured items and do blind taste
testing with students.
Taher says that food services is easily one of the most
competitive industries in today’s business world. The
way the company stays on top is by keeping its focus on
health and variety and finding the schools and districts
that are like-minded. “Our drive as an organization is to
always get the freshest and best food we can buy,” he says.
“We are constantly finding ways to make what we have
healthier and cleaner.” AHL
FMS Foodservice, a member of Affinity Group, is proud to be associated with
Trent Taher and Taher, Inc. “Food4Life” is not just a slogan but a mission for
Trent. Together we review better nutrition food items that don’t sacrifice
quality and taste; often at more expense than traditional school foodservice
items. Taher uses ingredients from leading manufacturers like Jennie-O
and Marzetti. Thank you Trent for teaching students healthy foods can also
be delicious!

Like Jennie-O, Trent Taher is committed to making
items available to more kids. That’s why we’re proud
Food4Life initiative with better-for-you products that
and delicious for kids to make smarter food choices in

One such product is our JENNIE-O Reduced Sodium Smoked Uncured Turkey
Franks. With only 240 mg of sodium per 2 M/MA serving and no allergens,
gluten, nitrates, or nitrites added*, our turkey franks are a nutritious alternative. Learn more about JENNIE-O Turkey Franks: jennieofoodservice.com

Nitrites Added.

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A Lean Expansion for
Reading Health System
David Schlappy implements lean design systems for the construction of the new, $346-million
Reading HealthPlex for Advanced Surgical and Patient Care

AHL APR.MAY.JUN 2017

By David Baez

22

The concept for the new Reading
HealthPlex for Advanced Surgical and
Patient Care was conceived in 2010,
two years before David Schlappy came
on board at Reading Health System. As it
turned out, however, a discussion that the current vice
president and chief quality officer had with executive
leadership would set the course for the eventual design
and functionality of the tower—a $346-million expansion
project that opened in the fall of 2016.
Prior to joining Reading Health, Schlappy worked with
another hospital expansion using a process called lean
design. Leadership at Reading Health gave Schlappy the
greenlight to bring in lean consultants to meet with the
executive team and put together a sound proposal. The
consultants conducted preliminary walk-throughs, data
collection, and interviews to assess the situation. Based
on what they learned, they determined the workflows
that would benefit from the lean approach. From there,
a steering committee organized project teams and began
scheduling process redesign meetings.
The concept behind lean, in simplistic terms, is to
design space and processes with an eye for reducing,
if not eliminating, waste. The goal is to boost the efficiency of the hospital and its workers, a benefit which
trickles down to the patients themselves. “When I talk
about waste, I’m talking about things that add no value
to patient care delivery, but still cost time and money,”
Schlappy says. “If we have a process that creates a
problem and we have to spend time and energy to fix it,
the better process is to never have the problem in the first
place. Lean is about finding out where the waste is and
setting up processes and physical space to eliminate it.”
Schlappy says an example of this occurred at another
hospital when it came to lab specimens. The specimens
arrive at the lab by tube and get checked in at a space
forty-five feet away. That forty-five foot jaunt by a technician may not seem like much, but consider the fact that
hundreds of thousands of samples are processed each
year. One can now see the degree of waste involved in
these thousands of miles of extra walking every year,
which does nothing to convert that sample into meaningful results for the doctor and patient.

A key principle in coming up with the lean design is
the importance of input from staff members directly
involved in the processes, rather than relying on outside
consultants. Schlappy and his team would have meetings
with twenty to thirty employees at a time broken down by
department and workflows to walk through the state of
the current system. These teams would locate examples
of the lean philosophy’s types of waste and decide how
things could be done differently. “Once you’re trained to
see waste, you see it everywhere,” he says.
There was a session with perioperative staff members,
one for the emergency department, and another for
patient care units. Medication administration, physical therapy, occupational therapy, materials management, and lab and diagnostic services all had their own
sessions, too. In short, everyone on the front lines was
involved. “The staff and physicians know the waste; they
see the symptoms every day,” he says. “They really were
empowered to work with the consultants to redesign
workflows. And there is much better adoption when you
have staff providing input, as opposed to a consultant dictating changes.”
Each group met for three consecutive days, and at the
end of each session, members of the team would report
back to the steering committee. One may presume that
workers who were accustomed to a certain way of doing
tasks might grumble over the changes, but Schlappy
says that because of their involvement in the process,
almost all the feedback was positive. “We pulled them
out of their regular job and asked them to help us work
on this,” he says. “So they felt valued and also knew that
the process they were helping design would make their
work better and better for patients.”
These sessions resulted in brand new workflows, with
compass documents stating all the major steps in every
workflow. The training itself was also designed around
the new workflows. In some cases, processes just needed
tweaking, and in other cases, a complete redesign was
in store. Schlappy says he foresees an enormous impact
from the design. “It will improve workflow and decrease
wait times for patients in the emergency department or
for those waiting for surgery,” he explains. “The other
people it will affect are the staff. If we can decrease the

DAVID SCHLAPPY
VP, Chief Quality
Officer
Reading Health
System

HPP Ad_AHL_One Third Pg_CMYK.pdf 1 7/28/2016 1:45:21 PM

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CM

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amount of wasted walking, searching for supplies and
equipment, or dealing with avoidable problems—which
is time away from a patient—that equates to more time
spent with the patient. By getting waste out of the system,
we can apply our clinical care more effectively.”
Perhaps just as important, Schlappy believes the mentality of the organization and its staff has undergone a
change through the collaborative process of coming
up with the design. He says when most people talk
about lean, they focus on the tools, which he believes
is a mistake. “It’s about engaging the staff; valuing and
respecting the individual,” he says. “People will go to a
seminar and talk about huddle boards, standard work, or
other techniques to drive improvement in patient care,
but those are just the tools. The tools support the desired
behaviors, but tools are not the end goal. The principle is
to engage and respect the staff’s contributions by guiding
continuous improvement efforts at the front line and
aligning each employee’s work with the organization’s
purpose. When you do that, you’ve tapped into something
about human nature that makes us want to do better. It’s
like fireworks going off.” AHL

The new tower is a
476,000-square-foot
surgical and inpatient
facility in Reading,
Pennsylvania.

AHLMAGAZINE.COM

Robert Polett

K

23

PULSE

Medicaidʼs Systematic
Transformation
John O’Hearn and Medical Center Health System use the Medicaid 1115 Transformation Waiver
to expand services for those most in need

AHL APR.MAY.JUN 2017

By David Baez

24

John O’Hearn likes to say that he’s been
in healthcare since he was a toddler.
His father was an internist, and his
mother was a social worker who served
on the board for Medical Center Health
System (MCHS), based in Odessa, Texas. “I’ve been in
or around healthcare most of my life,” O'Hearn, the vice
president of strategy and development for MCHS, says.
In O’Hearn’s lifetime, healthcare has seen some dramatic shifts. After a spell in pharmaceutical sales, he
returned to working for hospitals with MCHS in 2011—
right on the heels of the seismic changes created by the
Affordable Care Act. As Medicaid is a poor payer in terms
of reimbursement (O’Hearn says that MCHS gets about
40 cents on the dollar), MCHS and other hospitals were
working at a deficit from the beginning. Recognizing
this, the government stepped in and created the Upper
Payment Limit (UPL) program to make up the deficit,
and everyone was content. But then, in 2012, Texas
adopted managed care for Medicaid across the state,
which made hospitals suddenly ineligible for the UPL
and sent them back to the deficit.
“Every CEO and CFO ran for the hills because funding
was crucial to our bottom line,” O’Hearn recalls. “We all
counted on this funding.” The state had to circle the
wagons and figure out how to recuperate the lost money
back into Texas. In one of the rare occasions where
one saw Texas follow California, the state applied for a
waiver through the Social Security Act that California
had been using.
The Medicaid 1115 Waiver is basically a fund that pays
for uncompensated care, along with a Delivery System
Reform Incentive Payment (DSRIP), a progressive initiative that encourages hospitals to find unique projects
that increase access to care, improve infrastructure,
and provide better quality care and better access to that
care at a lower cost. Texas not only replaced the UPL
funding, which was about $15 billion, but was fortunate to increase the funding pool to $29 billion with the
introduction of the DSRIP pool.

JOHN O’HEARN
VP of Strategy &
Development
Medical Center
Health System

PULSE

Over the years, MCHS has
invested in the Ector County
Independent School District
(ECISD) for health education,
including at San Jacinto
Elementary in San Jacinto, Texas.
The health education platform
from MCHS provides teachers
with physical activity lessons they
can teach their students. Since
the launch, ECISD has logged an
additional ten million minutes of
physical activity.

AHLMAGAZINE.COM

What happened in Texas was distinct from what had
occurred in California, in which a total of twenty-one
public hospitals participated. In Texas, there are more
than 300 providers involved. This waiver opened up
funds to mental health authorities, county health departments, and academic physician practices, among others.
It represented a sea change from the UPL, leading to a
fundamental transformation of care rather than just
making up a loss. There are currently more than 1,400
statewide projects designed to increase access and
decrease cost.
“The UPL was kind of an accounting function. This
is true system transformation,” O'Hearn says. “Because
of the structure of the regional healthcare partnership
(RHP), it brought us all to the table to discuss what the
region’s needs really are.”
The program reorganizes the state into regions
(MCHS is in region fourteen, thus RHP 14) that are
similar in scope and size. It also assembles a group of
providers. In RHP 14, MCHS was made the anchor institution, and O’Hearn took on the role of program director. He also serves as a liaison among all the providers
in the region by coordinating reporting and sharing best
practices. RHP 14 has fifty-five projects and nearly $270
million in incentive payments it can attain.
The waiver allows MCHS to serve uninsured patients
(20 percent of all patients in Texas) more creatively and
broadly in ways that reduce the financial burden on the
system. Prior to this waiver, MCHS only had one lowincome family clinic, which was often overrun. The
waiver has now allowed MCHS to greatly expand care
to the population by opening a second clinic. When an
uninsured patient walks into the hospital, he or she is
assigned a navigator who assesses immediate social
and physical needs, begins the process of assigning the
patient a primary care physician, and works on providing
the patient with low-cost medications, sometimes even
a year’s worth of drugs for free.
“This doesn’t stop during the visit,” he says. “It could
be a ninety-day relationship we form with these patients,

25

PULSE

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“If something didn’t make
money before, it was hard to
convince people to dive into
it. Now we’re incentivized to
create programs and services
that meet a community need.”
trying to get them on the right course.” O’Hearn adds
that since the waiver was instituted, he’s seen incredible changes in the system, unfolding each day. He also
directly attributes 70,000 primary care visits to the
waiver across the region. Texas recently completed the
fifth year of the waiver and is now working underneath a
fifteen-month extension through December 2017 until an
agreement can be reached between the Texas Health and
Human Services Commission and Centers for Medicare
& Medicaid Services (CMS) on the structure and design
of a new waiver.
In the periphery of that discussion will be the debate
surrounding Medicaid expansion in Texas, which CMS
is pushing for, but that idea has been a non-starter in the
Republican-led Texas legislature. “The worry amongst
Texas hospitals is that we will be between a rock and a
hard place,” he says. “Both sides are pretty consistent in
their views, and unfortunately, the only people affected
are the patients that have been impacted by these programs. Without Medicaid expansion or a continuation in
waiver funding, many of these patients and the facilities
that serve them will be severely lacking in funding.”
O’Hearn adds that the waiver offered the opportunity
to try things that they’d wanted to do for a long time. “We
had all these great ideas that were sitting in the regional
hospitals,” he says. “If something didn’t make money
before, it was hard to convince people to dive into it.
Now we’re incentivized to create programs and services
that meet a community need but aren’t reimbursed. The
amount of lives impacted has been remarkable.” AHL

PULSE

Lahey Health Combats
Cancer with Compassion
Linda Weller-Ferris sees the Lahey Health Cancer Institute’s new Oncology Care Model
as a balance of empathy, diligence, and research
By Dan Caffrey

many of whom are facing side effects outside of the
direct symptoms of the disease. CMS is aware of this,
and as a result, it requires that all healthcare facilities
involved with the OCM screen every patient for clinical
depression. Weller-Ferris and her team are more than
up for the task. “There’s been some research that suggests 50–65 percent of cancer patients, at some point
during their cancer experience, will have become clinically depressed,” she explains. “We actually have oncology-specific social workers and a behavioral psychologist
who help a lot with the decision-making.”
She uses the decision to have a prophylactic mastectomy as an example. She says many patients don’t realize
how much their body image and sexuality will be compromised after the procedure.
“We try and slow it down and have our behavioral
doctor meet with [them],” she says. “We have lots of
support like that. We have acupuncture for pain. We have
pet therapy. We do music therapy. It’s asking, ‘How do
we get them through this experience with the greatest
amount of support?’”
Weller-Ferris applies this philosophy not only with
patients themselves, but also with patients’ families and
the caregivers she works with on a daily basis. “I have to
worry as much about the caregiving team burning out as
I do the patients,” she says. “The MAs care as much about
these patients as anyone else. That’s how it should be.
It’s not like you’re a surgeon, and after one post-surgery,
you’re sort of fine. This is a very relationship-based subspecialty that is very emotionally charged.” In fact, these
relationships often go beyond the typical model for care.
Weller-Ferris explains that she and her coworkers have
even planned anniversary dinners for many of Lahey’s
cancer survivors.
When it comes to the frequently elaborate requirements of the OCM, the logistical side of the project is
just as important as the emotional one. In order for all

LINDA WELLERFERRIS
VP of Lahey Health
Cancer Institute
Lahey Health

AHLMAGAZINE.COM

When Linda Weller-Ferris speaks about
her work, she might take up the better
part of ten minutes answering a question,
which is a noteworthy compliment. Not
every executive is so enthusiastic and
informative about the work they’re doing. But she has to
be because, to put it lightly, her work is quite complex.
As vice president of Lahey Health Cancer Institute,
she’s helping to implement an innovative Oncology Care
Model (OCM), a “five-year demonstration project” put
forth by the Centers for Medicare & Medicaid Services
(CMS) that involves improving the patient experience
and reducing the cost of healthcare. Lahey is one of only
196 national practices to be selected for this initiative.
The selection criteria—not to mention the scope of
the project itself—is extensive. In a nutshell, Medicare patients are paid at the normal service rate, with
Medicare paying an additional $160 per beneficiary, per
month, over a six-month period during any intravenous
and oral chemotherapy treatments. But all of this hinges
upon Lahey supplying data on its patients almost around
the clock, all in an effort to ultimately prevent emergency
room utilization and unplanned inpatient admissions. In
other words, it’s an abundance of heavy lifting for everyone involved.
But Weller-Ferris is the perfect person to accomplish this. Her background has given her a comprehensive outlook on an intensely complicated disease and
the equally complicated treatments that coincide. Her
background in mental health has been a vital asset. With
a bachelor’s degree in psychology, a master’s in clinical
psychology, and a PhD in educational and psychological studies, Weller-Ferris credits her experience with
helping her to be a more empathic leader. “You really
start to put yourself in the shoes of the patient,” she says.
As Weller-Ferris points out, this kind of emotional
support is crucial to working with cancer patients,

27

PULSE

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of it to be successful, Lahey has to cater to both. The
most striking example of this is perhaps Weller-Ferris’s
background in accreditation: she was the first non-MD
to serve six full years on the Accreditation Committee of
American College of Surgeons, Commission On Cancer
(ACOS). She views accreditation—a tricky balancing
act of emotionalism and practicality—as essential to
the OCM project.
“It helped to shepherd in the patient-centered standard for accreditation,” Weller-Ferris says about her
time at ACOS. At Lahey, they’ve “[flipped] into very
patient-centered standards that have very stringent
requirements, like you’re going to give every patient
a treatment summary and you’re going to give them a
surveillance plan of how they’re going to monitor their
function after treatment.”
She’s hoping that all of this will help everyone touched
by cancer—patients, families, and caregivers—have an
easier time fighting the disease. It makes sense that
such a complex illness would require an equally complex
remedy, a network that combines the seemingly disparate aspects of the humanism and the organization.
“If you’re going to be in the cancer business, you’ve
really got to attend to all of the details,” Weller-Ferris
explains. “That goes for accreditation, but it also goes for
what the expectations of Medicare and payers is going to
be: ‘Here’s your money. I’m going to give it to you to treat
this woman or this man.’ That’s where I believe we’re
going to be headed. I think that’s where cancer’s headed
long-term.” AHL

Over the years, I have had the opportunity to work
with Linda Weller-Ferris on several committees and
have always admired her energy and enthusiasm for
patient care. Her leadership skills and vision for where
healthcare is headed are inspiring. Congratulations on
your accomplishments as a well–respected Healthcare
Leader.
–Toni Hare, VP, CHAMPS Oncology

PULSE

The Significance of a
Well-Fitting Name
Why chief intellectual property counsel Nadeem Bridi’s inclusion in Acelity’s rebranding efforts was
critical to unifying the company
By Chris Gigley

NADEEM BRIDI
Chief Intellectual
Property Counsel
Acelity L.P. Inc.

AHLMAGAZINE.COM

When Acelity L.P. Inc. invited its chief
intellectual property counsel, Nadeem
Bridi, to attend meetings about a major
rebranding in 2014, he was more than
ready to participate. As it turns out,
his experience, combined with more than a decade of
service, made him unusually qualified to help throughout the process.
At the time, there was no unifying brand identity, and
since 2011, the company operated as separate business
units. At the core was Kinetic Concepts Inc. (KCI), which
was founded in 1976 by emergency room physician Dr.
Jim Leininger in a one-bedroom apartment in San
Antonio. KCI later introduced the first commercialized
negative-pressure wound therapy technology, V.A.C.
Therapy, in 1994. Bridi joined KCI as a patent attorney in
2001. He has been in his current role since 2009, overseeing and driving its global intellectual property portfolio.
Bridi jokes that the company wanted him in the branding meetings to represent the older generation. Participating employees shared stories about their experiences.
He recalls learning about different perspectives from
employees of LifeCell, which markets a unique tissue
regeneration technology born out of treating burn
patients. KCI acquired it in 2008.
He also learned about the rich history of Systagenix
Wound Management Ltd., the former wound-care
segment of Johnson & Johnson that KCI recently
acquired in 2013.
“Then I told my story about my involvement with KCI.
I talked about how V.A.C. Therapy treated some of the
worst types of wounds you could imagine,” Bridi says.

29

AHL APR.MAY.JUN 2017

PULSE

30

“Patients were literally on death’s door and had no other
options. They’d try V.A.C. Therapy, and a couple of days
later, surgeons would do a dressing change and gasp
when they saw how well it worked.”
He talked about meeting patients and doctors who had
used V.A.C. Therapy. He recalls being in the room with
researchers and scientists collaborating to improve the
technology. He also told stories of times that KCI and its
employees stepped up to help those in need by donating
products and time. KCI has been charitable after terrorist attacks and natural disasters, including in the 2010
earthquake in Haiti and the September 11 attacks in New
York City.
“I shared all that as we tried to build a new identity for
the company and realized we all had a common theme,
which was accelerating healing and bringing families
back together again,” he says. “Ultimately, we created a
word that truly evoked what we were about.”
In 2014, the switch to Acelity—the Latin root of the
term refers to accelerated healing—became official,
uniting the strengths of KCI, LifeCell, and Systagenix
under one brand.
“To be frank, it felt like before we were three companies stumbling along together, but when we branded as
one, it felt like a family coming together,” Bridi says. “You
can feel it when you walk the halls and go to different
locations, meeting different people who are coming on
board. It’s palpable.”
When Bridi started, KCI was celebrating its twenty-fifth year in business.
“My focus then was on V.A.C. Therapy products, which
have had many advances over the years,” Bridi says. “I
embedded myself with engineers and scientists and
learned about the products they were working on so I
could write the patents.”
His responsibilities have grown with the acquisitions,
but Bridi continues to stay close to product development
to stay abreast of all new advancements.
“I get to see ideas just created out of thin air from the
best engineers and scientists in our industry,” he says.
“My team and I work with them to extract those ideas,
putting pen to paper for the patents. As a patent attorney,
it is a privileged opportunity to be a part of a team that
brings such amazing products to the market. As in-house
patent attorneys at Acelity, we have the unique opportunity to see and influence how ideas become healing
technology. Ultimately, we get to meet the patients whose
lives have been made better by the work we have done.”
Bridi loves every part of the process. He remembers his

PATIENCE PAYS
first office at KCI fondly; he was
seated down the hall from both
Nadeem Bridi’s job has him on
the lab and manufacturing facilthe move so much that the chief
ity, and enjoyed the easy access
intellectual property counsel of
to both areas so he could learn
Acelity L.P. Inc. calls himself an
from everyone.
“accidental globetrotter.” As such,
Over the years, Bridi has not
he’s learned how to deal with all
just received an education from
the hassles of travel. “Don’t stress
engineers and scientists, but
out over things you can’t control,”
he’s also become their friend.
he says. “I’ve been delayed and held
And that has given him even
over, and you feel like the whole
more insights into the creative
world is against you. My patience
process. Often, Acelity scienlevel has grown, and I’ve learned
tists will simply be chatting with
that a warm smile and a kind word
him over lunch about a solution
is the best way to get where I need
they’re mulling over for a particto be.”
ular patient with a particularly
challenging wound. “I can see
the lightbulb go off and then a
few engineers get involved in the conversation,” he says.
“Often, I’m writing down notes as fast as I can, trying to
capture as many ideas as I can.”
Bridi says that when he started at KCI, only two
bookshelves held its patent documents, and the shelves
weren’t very full. Now, Acelity has about 2,700 patents
issued worldwide and more than 2,000 others pending.
Every once in a while, Bridi will find himself scanning the
halls of Acelity’s research facilities, where those patents
are memorialized in plaques and are a reflection of his
work there.
“It’s wonderful to see how much innovation has
expanded,” he says. “Managing that growth has been both
challenging and rewarding. As we’ve grown and been
successful, we’ve become the gold standard in the field.”
With this success, plenty of competitors have
attempted to imitate the company, but Bridi remains
undaunted. Those patents are tangible proof that his
team’s skills at protecting the company’s technology may
be as effective as the technology itself. AHL
Harness Dickey has obtained more than 55,000 patents for our clients since
our founding in 1921. We obtained 3,052 patents for our US clients last year
alone, earning us a top ten ranking among the nation’s patent firms in a
poll by IPWatchdog. Our team of 100-plus experienced intellectual property
attorneys handle patent prosecution, litigation, trademarks, copyrights, and
trade secrets on a global scale for clients that include Fortune 500 companies, private and public businesses, universities, inventors, artists, and entrepreneurs. Harness Dickey has offices in the metropolitan areas of Dallas,
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HARNESS DICKEY
IS PROUD TO JOIN THE
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IN RECOGNIZING

FOR HIS ACCOMPLISHED CAREER
AND CONTRIBUTIONS TO THE
HEALTHCARE INDUSTRY AS
ACELITY’S CHIEF INTELLECTUAL
PROPERTY COUNSEL

Keeping Kentucky
Up to Speed
The leadership of Carol Steltenkamp is fortifying University of Kentucky HealthCare—
and the rest of Kentucky—with twenty-first century record keeping

AHL APR.MAY.JUN 2017

By Kelli Lawrence

32

As University of Kentucky HealthCare’s
CMIO for ten years, Carol Steltenkamp
has gotten a daily dose of appreciation for
how far IT has come during her lifetime.
“When I went to college, IT was much
more about large machines in basements of buildings
with punch cards and all that,” she recalls, chuckling.
In sharp contrast with that image is, of course, any
snapshot of modern-day teenagers and young adults
wielding portable electronic devices of all kinds with
ease and expertise. “They would not consider doing
things without using a computer,” she says of millennials. “It’s their expectation of having information at their
fingertips for whatever it is they’re doing. It’s a given, and
the healthcare industry needs to meet that expectation.”
Steltenkamp has done her part and then some, as far
as the State of Kentucky is concerned. A still-practicing
pediatrician, she returned to school for her MBA, and
there, she was exposed to IT and consequently grew
excited for its prospects in medicine. “I could see the
vision of how we could use IT to improve health and
healthcare,” she says.
Around the same time, UK HealthCare was in the
midst of choosing an EMR for the first time. Steltenkamp’s involvement turned to leadership, which led to
her roles at UK HealthCare, first as physician champion,
then medical director, and finally as CMIO—the physician acting as a liaison between all other clinicians and
the IT department. “Early in my career, that would be

someone who translates a clinician’s medical record into
reality,” she says. “Now, it’s about leading the implementation of EMRs.”
But Steltenkamp’s work has extended well beyond
UK HealthCare’s ample boundaries. Steltenkamp also
served as principal investigator for a grant received by
the Kentucky Regional Extension Center (REC) that
brought in more than $10 million so that smaller providers could implement, adopt, and use EMRs as well.
The US Health Information Technology for Economic
and Clinical Health (HITECH) Act, which is part of the
Affordable Care Act, allowed for the entire state to be
covered. “That was incredibly ingratiating,” she says. “I
really felt good that we were able to lead the Kentucky
REC. The grant dollars are gone, but they continue in a
nonprofit way now.”
In addition to all of this, Steltenkamp is also cochair
of the board for the Kentucky Health Information
Exchange (KHIE), an organization that helps facilitate patient care when going beyond their hometown
becomes a necessity. Plus, Steltenkamp only recently
completed her term as chairperson of the international board of the Chicago-based Healthcare Information and Management Systems Society (HIMSS),
where she says she had the privilege of being involved
in the nonprofit organization’s transition from
national to international. The impact of HIMSS—
which operates with the goal of using IT to improve
healthcare rather than to simply make records more

accessible—can now be felt in
Europe, Asia, and parts of South
America and Australia.
Regardless of location, Steltenkamp has found that clinicians in
their forties and fifties tend to be
the most difficult to convert to
EMR technology. “It’s difficult to
be an adult learner and change
the way you do things,” she
admits. But she knows how critical it is for that change to happen.
“If you want to stay in the game
of educating our next generation,
you have to be on top of that, or
the patients will go elsewhere,”
Steltenkamp says. “That’s where
the demand is. They have to shift.
Even if the doctor is thinking,
‘Why change? It’s just between
me and my patients,’ it’s not. It’s
also about the residents and other
younger personnel. You have to
change for them.”
Change in her home state is perhaps Steltenkamp’s
greatest source of pride, with Kentucky REC and KHIE
making it possible for people in smaller and/or more
rural communities, such as the Appalachians of eastern
Kentucky, to get EMRs. The goal, of course, is for the
technology to manifest as improved healthcare. “To be
able to step outside of the university while having UK’s
blessing . . . what a great opportunity to go out and serve
and help others,” she says. “Which is really the right thing
to do for all our patients.”
As for the future of UK HealthCare itself, Steltenkamp looks to continue putting it in a position to meet
the needs of the Medicare Access, as well as the US CHIP
Reauthorization Act of 2015 (MACRA)—to step up to
that federal regulation, she says. Continuous evolution
and optimization of EMRs is key to that process.
“I also want to beef up educational offerings around
health IT,” Steltenkamp says. “All six medical colleges
at UK are within walking distance of each other, which
allows for great collaboration possibilities.”
Those collaborations can now be shared with the
entire state. “UK HealthCare is truly dedicated to the citizens and the commonwealth of Kentucky,” Steltenkamp
says. “That’s what makes it a privilege to serve here.” AHL

CAROL
STELTENKAMP
CMIO
University
of Kentucky
HealthCare

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One Platform for
a Mobile Migration
With a recent switch to a Cerner Millennium platform, CIO Kent Hoyos is moving on a
series of technology-integration goals at Pomona Valley Hospital Medical Center

AHL APR.MAY.JUN 2017

By Urmila Ramakrishnan

34

From applications that can ensure the
correct breast milk goes to the right
baby to streamlining records across
different departments, integrating
technology is no small task for hospital
systems today. For the Los Angeles-based Pomona
Valley Hospital Medical Center (PVHMC), it’s all about
accessibility to the end user. For CIO Kent Hoyos,
that equates to a series of long- and short-term goals
to replace antiquated technology with systems and
applications that work across the enterprise to serve its
diverse patient population.
The hospital has been a long-standing customer of
Siemens Health Services and its Soarian platform. In
fact, it was one of the first systems after the advent of
the Internet that was to be written from the ground up,
Hoyos explains. “It just didn’t come to fruition across the
whole board,” he says. “So we’re sitting here in a place
where we have some holes, and at about the same time,
Cerner purchased Siemens in 2014. They made a statement that they were going to do a like-for-like offering.”
In November, PVHMC signed a contract to switch to
the Cerner Millennium platform. “We found that the
Soarian world of development felt a little slow, as you
would imagine,” Hoyos says. “The other side of that was
that it was beginning to feel like we’re some of the last
rats on the ship kind of a thing, so we want to move as
quickly as we can to get to what the future holds for us.”
In order to do that, he developed the strategy to make
his subsequent new goals fit the entire organization. For

KENT HOYOS
CIO
Pomona Valley
Hospital Medical
Center

Hoyos, it’s really about discussion and communication
with the organization’s associates to make sure his team
is moving in the same direction, with the same priorities
as the organization. Hoyos takes the time to involve his
clinicians, physicians, and community. He leads with
transparency in developing goals while keeping patient
care in mind by surrounding himself with clinicians.
Because of that, he’s been distilling the hospital’s many
applications into one platform, which will eliminate the
need for multiple devices. This makes the experience
inherently easier for the end user to understand where
to go for that specific application. The department also
won’t have to manage different platforms, multiple
updates, and multiple access points. “One way to do it is
the better way to go for us,” Hoyos says.
It also addresses the expectations people have surrounding technology. It's fair to say that everyone wants
the latest gadget in tech, from the iPhone 7 to VR headsets. There’s an intrinsic want for the latest, greatest
thing. But integration creates a sense of equality because
everyone gets his or her applications this way. This
means integrating an application that tracks breast milk
to make sure it goes to the matching baby with mobile
blood-draw applications with an alerting platform that
indicates new results and admissions.
By switching systems and integrating applications,
Hoyos also has to focus on community connectivity.
His goal is to get outside entities on board with the
understanding that the data is good for their system,
too. “We’re having people on one side who are used to

PULSE

certain applications and vendors,” he says.
“It’s what they’ve learned to do, and it’s hard
to change, even for IT folks. We want to keep
those people and make sure they understand
that they are part of our future.”
There have been a lot of challenges presented with trying to create community
connectivity. “We’re a not-for-profit hospital. We don’t own our doctors,” Hoyos says.
Because of that, there are many systems out
there with patients who might be on the same
system—but they have different opinions on

“It’s not a Kent choice, or a
one-of-my-staff choice. It’s an
organizational decision that we
really need to make as a team
to ensure that these things are
understood and evaluated so we
can move forward.”

AHLMAGAZINE.COM

how they want to use it. Hoyos is focused on
how to make the environment meaningful for
all—not just checking a “meaningful use” box.
Another goal for Hoyos is updating the
hospital’s data center. Being that it’s in the
basement of the organization’s hospital in
California, there are seismic upgrades and
construction issues that go into the day-today use issues. On top of that, part of the data
center is in a building that was constructed
in 1972. Hoyos is working on a plan to create
a new data center, and PVHMC is considering moving the servers into its own building
or creating a multi-use building that houses
data. It’s been all about choice: how much of
the old does one keep while moving forward?
“It’s not a Kent choice, or a one-of-mystaff choice,” he says. “It’s an organizational
choice that we really need to make as a team
to ensure that these things are understood
and evaluated so we can move forward.” AHL

35

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An Educational
Emphasis
For St. Joseph Health's Dr. Jack Cox, teaching is key to placing
patient well-being at the center of clinical progress
By Denise Dooley

AHL APR.MAY.JUN 2017

JACK COX
Chief Quality
Officer, Senior VP
St. Joseph Health

36

When Dr. Jack Cox
speaks of valuing every
individual employee
of the sprawling Providence St. Joseph Health
(PSJH) healthcare network, he is not
merely trading in platitudes. Cox speaks
from experience. As a young man in
Knoxville, Tennessee, he first worked in
environmental services at Fort Sanders
Presbyterian Hospital to put himself
through college.
One of his responsibilities included
cleaning rooms, and he realized the key
role of all healthcare professionals is the
well-being and safety of patients. “If an
infected patient leaves a room that is not
properly cleaned, it jeopardizes the safety
of the next patient using that room,” Cox
notes. “Healthcare is a team sport. Every
single employee contributes to the standard of care and to the hospital mission.”
As he discusses his new responsibilities as senior vice president and chief
quality officer at PSJH, it is clear that
the scale of this 100,000-caregiver and
fifty-hospital operation does nothing to
diminish his passionate concern for the
welfare of each patient. “Everyone who
works at a hospital is a caregiver,” Cox
says. “Even if you are not providing care
to the patients directly, you’re caring for
those who do. That’s important.”
Cox followed his early mop-pushing
days with a medical education at the
University of Mississippi School of Medicine. After his eight-year US Air Force
stint, which included a tour in England as
the chief of clinical services and a teaching assignment at Travis Air Force Base,
Cox was recruited to run a family practice
residency program in Pennsylvania, followed by the development of a residency
program at Intermountain Healthcare’s
Utah Valley Medical Center.
“Every job I’ve ever taken could be
described as something that I haven’t
done before,” Cox says. “You have to trust
what skills you have, always look to learn
new ones, and learn how to apply them to
new challenges.”
Teaching and learning are one and the
same in his philosophy. “It is fundamentally our responsibility to train new phy-

PULSE

AHLMAGAZINE.COM

sician leaders,” he adds. “The Latin root
for ‘doctor’ means to teach. The doctor’s
role is always to be teaching and developing others.”
His studies, teaching, and leadership
brought Cox all over the country, and he
picked up extensive systems experience
and a business degree from Tulane University along the way. In Utah, he met
Dr. Brent James, a trailblazer in clinical
quality with whom Cox worked to develop
and implement one of the first residency
curricula that emphasized quality and
performance improvement skills.
These lessons served Cox well in his
next role as senior vice president and
chief medical officer for Premier, an alliance of 2,000 nonprofit hospitals, where
he created its first Clinical Performance
Improvement department and developed
and implemented its strategic direction.
Once again learning at the feet of other
pioneers in healthcare quality and safety,
including Dr. Don Berwick, Dr. Gene
Nelson, Maureen Bisognano, and Carol
Haraden, Cox’s team developed a method
of identifying leading practices in specific
clinical conditions and procedures, while
sharing this knowledge through a collaborative model.
The successes of this program led
to the health quality improvement
demonstration with CMS, a pioneer
pay-for-performance model. Decreasing
variation and improving the reliability
of care was a driving force for this successful model. As Cox explains: “There
is a false assumption that every person
is different, that you can come to expect
variation in the care provided. But it
simply isn’t the case.” He believes that
each patient should come to expect—and
receive—safe and excellent care at every
step along the way.
After sixteen months as the senior vice
president and chief medical officer, Cox
switched roles to join the team tasked
with guiding the St. Joseph Health and
Providence Health & Services organizations through a major partnership
merger, acting as the newly minted senior
vice president and chief quality officer
of PSJH. He is quick to note that this
process is running smoother than many

37

PULSE

AHL APR.MAY.JUN 2017

“The Latin root for ‘doctor’
means to teach. The doctor’s
role is always to be teaching
and developing others.”

38

During a recent
foundation
event, Dr. Jack
Cox (second
from left)
joined (left to
right) Dr. Burt
Eisenberg, Dr.
John Lipham,
and Dr. Louis
VanderMolen
for a
discussion
about cancer.

for a rather high-minded reason: the shared missions and
values of the founding Sisters of St. Joseph of Orange and
the Sisters of Providence align beautifully. Both orders
emphasize service, access, and affordability. Generosity
and excellence are crucial to Cox’s work, and his unique
array of vantage points and work experiences in both lead
and support roles help him to make these values tangible
in each and every patient interaction that takes place.
PSJH now comprises a major system of integrated
medical services, which provide an array of healthcare
services to more than twenty-two million people in seven
states. The one factor this development makes certain
is that Cox’s agile and energetic administrative talents
will have a directly positive impact on millions of Americans, bringing professional support and excellent care to
patients, doctors, and caregivers alike. AHL
PerfectServe is honored to serve Dr. Jack Cox and his team at St. Joseph
Health to enable clinicians to enhance the quality of care by speeding time to
treatment. PerfectServe Synchrony is healthcare’s most comprehensive and
secure care team collaboration platform. Its proprietary Dynamic Intelligent
Routing facilitates communication-driven workflows that enable time-sensitive care delivery. The single platform architecture is designed to transcend
geographic and organizational barriers and drive collaboration among all
stakeholders across all care settings. Over 100,000 clinicians in organizations like St. Joseph Health rely on PerfectServe Synchrony to help them
enhance patient experience and reduce HIPAA compliance risk.

Healthcare’s most
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and secure care
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PerfectServe Synchrony™ is unique in its ability to improve communication process
accuracy and reliability via its proprietary Dynamic Intelligent Routing™ capability,
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for any given clinical situation at every moment in time.
More than 100,000 clinicians in forward-looking organizations across the U.S. rely on PerfectServe
Synchrony to help them speed time to treatment, expedite care transitions, enhance the patient
experience and reduce HIPAA compliance risk.

â&#x20AC;&#x153;Soviet Ukraine
was a whole
different reality,
where a girl like
me would never
even dream to be
what I am now.â&#x20AC;?

LIFE

LIFE

The Road to

Inclusion
From Taiwan to Kansas, Nashville to Indianapolis,
Sonia Chen Arnoldâ&#x20AC;&#x2122;s career path has been one of twists
and turns that have led to her most fulfilling work yet
as assistant general counsel at Eli Lilly

Raised by a lawyer and a musician,
Sonia Chen Arnold was taught early in
life to balance art and academia and to
always prioritize education. Her father
had earned his master’s degree in law
from the University of Missouri–Kansas City after
moving his young family from Taiwan to Kansas; her
mother is a pianist and holds a degree in music from
Chinese Cultural University in Taiwan. Arnold herself
originally pursued liberal arts over science, majoring in
violin musical arts at Vanderbilt University.
However, during a fiddling class taught by the
award-winning musician and composer Mark O’Connor, Arnold heard something that changed her trajectory.
“Anyone can be a musician,” the guest lecturer said that
day. “But the only people who should be musicians are
those who can’t live without it.”
While she was a good student and accomplished in her
craft, Arnold realized that she was too multi-passionate to
dedicate her time exclusively to music. So, she took on a
second major in human and organizational development
and an internship at a music publishing company, where
she became acquainted with the business side of music.
While filing copyrights for songwriters there, she
discovered her interest in the industry’s legal side and
decided to go to law school to become an entertainment
lawyer. Having moved to Indianapolis during elementary school, Arnold decided to attend the Indiana University School of Law in Bloomington. Arnold would
then spend the first eight years of her career in private
practice as a litigator.
The epitome of success for a private practice attorney is to become an equity partner of a law firm. In 2011,
Arnold had sacrificed the necessary
blood, sweat, and tears to do so and
was preparing for her vote that fall
when she got a call about a rare
opening at the global pharmaceutical giant Eli Lilly.
AWARDS
“I was so close to making partner,
and I wanted to prove to myself that I
In 2016, Eli Lilly was ranked
number seven out of one
could do it,” she says. “On top of that,
hundred on the Thomson
I would’ve been the first Asian AmerReuters Diversity and
ican and second ethnic minority out
Inclusion Index, which
of more than one hundred lawyers at
evaluates thousands of
the firm to make it into the partnerpublicly traded companies
ship from being an associate—not
worldwide.
to mention a woman—which made
For the twenty-second year, Eli
me a mentor to a lot of associates.”
Lilly has earned a place among
But Arnold was raised to never turn
Working Mother magazine’s
down an opportunity without learn“100 Best Companies” for its
ing about it first, so she applied for
efforts in the advancement of
the job with low expectations.
women, child care, and paid
parental leave.
She interviewed, and after
meeting Eli Lilly’s general counsel

45

AHL APR.MAY.JUN 2017

LIFE

46

and learning about the company, its
work, and her own upward potential, Arnold was intrigued. She had
been pushing so hard to make tiny
strides for diversity at the law firm,
but at Lilly, she saw the opportunity to make contributions to a
more advanced culture of diversity
and inclusion that still had room
for improvement.
Additionally, Arnold felt the new
position would not only allow her to
be more than an example for other
women and minorities, but also
make a difference in the careers of
other young attorneys. When faced
with the choice to stick with her
original plan for success or explore
a completely new path with great
potential, she had to ask herself: will
being a partner make me happier?
Arnold joined Eli Lilly in May
2011 and has never looked back.
Now assistant general counsel
for Lilly’s Litigation & Legal Compliance Center of Expertise, Arnold
uses her influence to promote Lilly’s
company-wide commitment to
diversity and inclusion every day,
in part by helping to manage Lilly’s
Preferred Outside Counsel Program.
“I work with amazing law firms
across the country, with highly
intelligent lawyers,” she says.
“When they’re working on Lilly
projects, I want to see a team that
includes women and minorities—associates and partners with
diverse backgrounds.”
In this way, Arnold is able to
directly invest in both the future
success of other attorneys and
to better serve Lilly’s customers.
“Making sure our employees are as
diverse as the millions of people we
serve is crucial to our success—and
that includes the legal department,
outside counsel, and our vendors,”
she says, emphasizing that championing diversity is an important way
to make meaningful contributions
to business needs.
“When I mentor people who are interested in law, I
always tell them to not be so focused on what you ‘should’
do,” Arnold explains. “Ultimately, it’s more important to
find something that you enjoy and have a passion for
because if you don’t, you won’t do well.” At the same
time, Arnold—who is married to a corporate attorney in

onia Chen Arnold
S
was recognized
as a “Rising Star”
by Indiana Super
Lawyers in 2008,
2009, and 2011.

LIFE

“Making sure our employees
are as diverse as the millions of
people who use our medicine is
crucial to our success—and that
includes the legal department.”

partnerships
Decades of Experience
Ice Miller was an early pioneer in
the defense of pharmaceutical and
medical device products that
improve the health and well-being
of patients around the globe. Ice
Miller’s long standing leadership
and cost-effective, creative
commitment to defending these
important, life changing products
and the companies who make
them continues today.
Chicago Cleveland Columbus DuPage County, Ill.
Indianapolis New York Washington, D.C.

icemiller.com

Ice on Fire

AHLMAGAZINE.COM

private practice and has a nineteen-month-old daughter­—acknowledges that you can’t do everything.
Professionally and personally, Arnold prefers to spend
her time doing things that can make a difference. In this
spirit, she has narrowed her volunteer time to the boards
of three organizations. One is as a member of the Board
of Visitors for the IU Lilly Family School of Philanthropy,
the world’s first school dedicated solely to the study and
teaching of philanthropy.
Lilly Endowment, Inc. made the initial planning
grants that launched the school’s predecessor, the
Center on Philanthropy at Indiana University, more than
twenty-five years ago and has provided substantial
support throughout the school’s history.
She also sits on the board of the International Violin
Competition of Indianapolis. The competition brings
forty of the world’s brightest musical talents from around
the world to Indianapolis every four years to compete
for a unique prize package that includes a cash reward, a
recital at Carnegie Hall, the loan of the 1683 ex-Gingold
Stradivari violin, and professional assistance in launching a violin career.
Arnold is also a board member of the Asian American
Alliance, an organization that exists to empower
Asian Americans to lead and serve in businesses and
communities as a way to engage and enhance their
leadership potential.
“I’m a prime example of why Asian Americans need to
be empowered to actively seek leadership roles,” Arnold
says. “If I hadn’t taken risks and embraced opportunities
to lead, I wouldn’t be where I am today.”
Arnold follows a drive for diversity and inclusion to
the center of her personal success and satisfaction. She
has maintained her parents’ example of balancing art
and academia and, along the way, discovered that using
her time and legal expertise to enhance lives, to advance
careers, and to speak up for minorities is the thing she
cannot live without. AHL

47

LIFE

Taking Charge of
the Controllable

Simon Manoucherian’s journey from Iran to his current role as deputy general counsel at Grifols is a testament to the
power of ethical determination and education

AHL APR.MAY.JUN 2017

By Amanda Garcia

48

Soldiers patrolled the streets as the van
delivered precious cargo to the airport.
Martial law had been declared, but was
failing to calm the upheaval in Iran in
1978. Simon Manoucherian’s PolishArmenian great-grandparents on both sides had immigrated to Iran before he was born. Almost half of the
world’s ethnic Armenian population has lived outside
of Armenia for generations after the genocide of Armenians by the Ottoman Empire and, subsequently, by the
Turkish Republic at the turn of the twentieth century.
Now, thanks to this van and the friend who drove it,
they would move again to escape the radial Islamic revolution. “Sometimes things happen that are out of your
control,” Manoucherian’s father said to his five-year-old
son as they boarded the plane to America.
Seeing his parents leave everything behind to make a
better life for their family taught Manoucherian the value
of determination and hard work. Watching his parents
learn a new language inspired his passion for education.
Paying attention to the way they kept the family together
in the face of hardship taught him resilience and faith.
“My parents taught me to overcome obstacles,” he says.
“They taught me to keep pushing, be a good person, and
never underestimate the value of education.”
Manoucherian was enrolled at a private Armenian
school, and in fourth grade during the weekly religion
class, he memorized the Ten Commandments. The commandments inspired a budding interest in law—including common rules such as traffic lights, crosswalks, and
signs that designate who is allowed to park where and
when. He realized that all rules boiled down to those ten
ancient commandments in one way or another. He was
fascinated by whatever it was inside human beings that
compelled them to obey. After school that day, he went
home and told his parents he wanted to be a lawyer.

By sixth grade, Manoucherian could perfectly recite
the Miranda rights, loved the concept of being innocent
until proven guilty, and had developed a passion to read
and learn. His fascination with law, coupled with his
parents’ values and work ethic, motivated him through
California Lutheran University (where he graduated
magna cum laude with a bachelor’s degree in political
science), Southwestern Law School (where he was associate editor for the Law Review, a member of the Moot
Court Honors Program, and in the top 10 percent of his
class), and the beginning of his career. Before the age of
forty, Manoucherian had become an equity partner at a
private firm and had reached what he believed was the
pinnacle of legal practice.
Meanwhile, he also met his wife. For a time, they
were both content to be consumed by work, but when
she became pregnant and her grandmother died in the
same year, their mindset began to shift. “We had to take
a few days off for the funeral, and I realized it was the first
time I’d slowed down in years,” he says. “It gave me the

1978
Immigrated
to the United
States

1991
Gained US
citizenship

SIMON
MANOUCHERIAN
Deputy General
Counsel
Grifols

1998
Graduated
from
Southwestern
University
School of Law

LIFE

THE AMIN LAW GROUP, LTD.

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opportunity to think about how I would balance work and
fatherhood.” A few days later, a compelling email from on
old boss arrived with an intriguing in-house opportunity.
Grifols is a multinational biopharmaceutical and
diagnostics company that is a leading global producer
of blood plasma-based products. “When I came here, I
was blown away,” Manoucherian recalls. “Thirty days
later, I joined as senior counsel and director of litigation.”
That was September 2008, and three months later, his
twin boys were born. “This company supports work-life
balance, and my whole team supported me in my work
when my babies were born,” he says.
Manoucherian has since been promoted to Grifols’s
assistant general counsel and then to deputy general
counsel in June of 2016. He also knows his work is
directly helping a company that’s having such a powerful impact in healthcare. “When I give the ‘Welcome to
Grifols’ talk at new employee orientation, I love to say
that my team and I are the only lawyers I know who save
lives,” he says. “We are part of the entire process. If we do

Holland & Hart
is a full service law
firm with more than 500
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“We believe we have the
technology to build the
foundation that a deficient
immune system needs.”
our jobs right, people get access to our life-saving drugs
and diagnostic machines.”
As head of all legal operations in North America,
Manoucherian is committed to understanding all aspects
of the business. Most of Grifols’s medicines are made of
plasma, so he has visited several of its 162 donor centers.
He is also familiar with operations at the two main US
manufacturing hubs and international offices, including
Grifols’s global headquarters in Barcelona.
Manoucherian is dedicated to building trust with his
team through collaboration and shared responsibility.
“I relish this role, and I’m so proud of this company,” he
says. “It’s a lot of work, and I know I couldn’t balance
everything without such an amazing team.”
Appreciation for others is a company trait, and pride
and passion for donors, patients, and employees is
ingrained in Grifols’s culture. One project that he is particularly excited about is Grifols’s Convalescent Plasma
Collection Project—a system that is dedicated to fighting
emerging pathogens around the world by collecting antibody-rich, hyperimmune plasma from donors who were
sick and have recovered. In Liberia, for example, Grifols
collected plasma from Ebola survivors.
In a complex process, plasma is broken down into core
units used to develop medicines to fight specific illnesses.
“We believe we have the technology to build the foundation that a deficient immune system needs,” he says.
“Grifols engineering, as well as manufacturing, is famous
for turning concepts like these into reality.”
Whether it’s developing life-changing medical
resources, pursuing a career in law, learning a language
(he fluently speaks four), or moving to a new country, he
has become an expert at turning concepts into reality. He
has always had a passion for bettering human life (which
happens to be Grifols’s ultimate mission), and he knows
his father’s determination, his mother’s consideration,
and his integrity are the components to do just that. AHL

On a Sunday afternoon in late May 2011,
an EF5-rated multiple-vortex tornado
struck Joplin, Missouri, with winds
exceeding 200 miles per hour. At nearly
one-mile-wide, it cleared a large path
along the southern part of the city where, at the epicenter
of the storm, St. John’s Regional Medical Center stood.
It was just four days earlier when the hospital had
serendipitously completed its annual “all hands on
deck” earthquake drill, so the staff was prepared for the
disaster. All 169 patients were evacuated within ninety
minutes, and a triage center was quickly established
nearby. Physicians who had been working all day stayed
on to help throughout the night, many of whom worked
up to thirty-six hours straight.
The next day, Lynn Britton, president and chief executive officer of Mercy, made a major statement that the
hospital in Joplin would be rebuilt and retain all employees. The corporate headquarters shipped computers to
Joplin, so offices could be set up in a local convention
center, and a MASH-type tent served as Mercy’s first
temporary structure in a line of three temporary hospitals. At the same time, Mercy Joplin’s leadership
team quickly set to work. The immediate plan was to
design and build a state-of-the-art facility and retain
its devoted staff in the years it would take to do so.

SHELLY HUNTER
CFO
Mercy Hospital
Joplin

AHLMAGAZINE.COM

Tina Smith

By Amanda Garcia

51

LIFE

AHL APR.MAY.JUN 2017

“It would have been so easy
for Mercy to walk away from
us, but instead they invested
in us over the four years it took
to rebuild.”

52

Meanwhile, chief financial officer Shelly Hunter and her
finance team were taking the long view as they started
planning for future growth. Mercy had lost 50 percent
of its market share as a result of the disaster, but it was
determined to regain it all and increase volume.
These ambitious goals would have been impossible
without a dedicated team and a committed ministry
leadership. “The cost was $150 million after FEMA and
insurance to support the losses,” Hunter explains. “It
would have been so easy for Mercy to walk away from
us, but instead, they invested in us over the four years it
took to rebuild.”
During the rebuild, Hunter managed current construction expenditures while maintaining steady ongoing
operations at the temporary hospital. She worked closely
with construction partners to stay within budget, while
also working closely with FEMA to ensure funding and
with the insurance company to negotiate claims.
“We needed to set ourselves up for success in the
future, which required projecting volume as accurately as possible,” she says. As financial strategist and
planner, Hunter also developed strategic initiatives to
drive the hospital forward to greater growth. “Balancing
the current projects and future growth required a lot of
focused work and a great team of brilliant, talented analysts,” she says.
Corporate construction partners were highly supportive, along with the project manager, hospital leadership
team, and the Joplin community itself. “It was a lot of
fast-paced work for all of us,” she says. “But we pushed
through knowing there was a light at the end of it all.”
The planning of a building of this size and complexity
typically takes a minimum of about two years, but Mercy
won construction awards for breaking ground in January
2012—just eight months after the tornado struck. And in
2015, Mercy moved into its new state-of-the-art, $460-

million facility, complete with tornado-rated safety
measures. “During the transition period, we coined the
term ‘change fatigue,’” Hunter says. “But our folks are
incredibly resilient, and we made it through together.”
As a result of the phenomenal combined effort of many
teams, Mercy is now the preferred provider of most
service lines in Joplin. By summer 2016, the hospital
had regained 5 percent of its market share, the budget
was met, and volume targets had been hit and exceeded.
Mercy even made a $24 million cost improvement (not
considering depreciation) in fiscal year 2015 thanks to
Hunter’s team of efficiency experts.
Of course, maintaining the most efficient cost is worthless without also ensuring the highest quality healthcare.
Achieving both also requires intensive planning in a constantly changing environment. “That’s why my work is so
fun,” says Hunter, whose skill set and idealistic-thinking
approach was an exceptional fit for the project. “I call it
a Rubik’s Cube because all those moving parts are constantly affecting each other.”
One key advantage to Hunter’s successful financial
strategy is the fact that she grew up in the Joplin area
and understands the population, as well as where Mercy
might succeed in certain outlying areas. Her twenty years
in healthcare have helped her understand how to apply
national trends to the plan. Putting all those together is
perhaps Hunter’s greatest strength, giving her a view of
the whole picture: Mercy’s strengths, Joplin’s needs, and
the growth required to break even and cover all depreciation costs within two years of opening (by June 2018).
Ultimately, Mercy Hospital Joplin is a ministry with
a mission to transform the health of the community it
serves. “You can’t succeed here if you have a big ego,”
Hunter says. “Everything has to be about caring for the
patient and the greater good of the organization.”
Approaching their work with that service mindset is
a defining characteristic of the Mercy team, as is their
relationship-oriented commitment to the community.
It’s a key reason why they banded together in the face of a
disaster, stuck together through the rebuilding years, and
continue to stand united and grow into the future. And
while planning and strategy are certainly essential, it’s
Mercy’s commitment to quality, service, and each other
that can weather any storm. AHL
Siemens Healthineers is committed to becoming the trusted partner of
healthcare providers worldwide, enabling them to improve patient outcomes
while reducing costs. Driven by our long legacy of engineering excellence
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Perhaps that’s why nine out of ten hospitals in the U.S.
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Along with our new name comes a renewed commitment.
We will do all we can to enable our partners’ success,
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Learn more at usa.siemens.com/healthineers.
1
2

Forging Ahead in
No Woman’s Land
Janice Klostermeier reflects on her path to healthcare finance—and what its hurdles say about
the uphill climb for women to the C-suite
By Kelli Lawrence | Photos by Kristin Deitrich

Her grades started to slide. At age twenty-five and
pregnant with her first child, Klostermeier had enough
credits to graduate but a subpar GPA in accounting
courses, so she tracked down a school administrator for
assistance. “I was told the school didn’t need students
like me who couldn’t get out on their own merit,” she
recalls. “It was a horrible thing to say.”
But Klostermeier bounced back, getting on the phone
the next day to schedule an appointment with the university president. Not only did he say that she was free
to graduate, but he also assured her that she was exactly
the kind of student UTA was proud to call its own. She
accepted her first opportunity in the healthcare industry
that very same year.
However, in the late 1980s, Klostermeier says, the field
didn’t carry the same reverence that it does now—particularly with accountants. Those with the best transcripts
were striving for a start with one of the “Big Eight”
accounting firms at the time, including Ernst & Whinney
and Coopers & Lybrand. Klostermeier, meanwhile, took
an alternate route. “My job wasn’t sought after,” she says
about the position at her first healthcare company, which
involved internal auditing. “I just barely had my fingers
on the bottom rung of the ladder.”
What she soon realized, though, was that she was surrounded at this job by former public accountants that had
burned out quickly with those big-name employers and
came to healthcare seeking a calmer, lower-pressure
work environment. This led to Klostermeier receiving
“Big Eight”-style training, which in turn led to her ascent
up the healthcare ladder. Four years after her UTA graduation—and not yet thirty years old—she found herself
thriving as the CFO of a one hundred-bed hospital.
The road between that CFO position and her current
one was more a cherished scenic route than an express
lane. Klostermeier was system controller in a couple
of different locations before consulting independently.

JANICE
KLOSTERMEIER
CFO
Hollywood
Presbyterian
Medical Center

AHLMAGAZINE.COM

It happened many years ago, but Janice
Klostermeier vividly recalls the conversation that kept her from her first CFO job
in a major hospital. She had spent nearly
two decades in the healthcare industry
by then—including the past two years in senior management for a hospital. She held a master’s degree in healthcare administration; she was also a CPA and a Fellow of
the American College of Healthcare Executives. “I had
credentials none of [the other applicants] had,” she says.
Nonetheless, the hospital’s CEO quelled the possibility
with just one sentence in a face-to-face conversation: I
can’t put a woman in that position.
“And that went straight to my heart—this was the twenty-first century, not the Dark Ages,” Klostermeier says,
incredulously. “But I immediately recovered because one
of the things you do in this business as a female is recover
quickly—and don’t ever become a victim. I said, ‘I appreciate your position on that. . . . What can you do for me?’”
What he could do for her wasn’t nearly enough, considering that she started working—quite successfully—
as an independent consultant shortly afterward. Today,
Klostermeier is the CFO at the Hollywood Presbyterian Medical Center in Los Angeles. That’s not bad for
someone who says she has “gone about everything the
wrong way” in her career.
That journey logged a lot of miles in Texas. Not only
was Klostermeier born and raised there, but she had
spent many years in the Lone Star State pursuing higher
education—first at a junior college and then at University
of Texas at Arlington (UTA). She married at nineteen and
worked as a secretary and bookkeeper, a job she started
just days after graduating high school. It was admittedly
a lot on her plate for an extended period of time. “I’d graduated high school and junior college with honors,” she
recalls. “But after slogging through seven-and-a-half
years without a break, you get burned out.”

55

LIFE

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56

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Meanwhile, she raised her children, divorced, and then
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as the CFO (and, eventually, chief administrative officer)
of the largest privately held emergency medical group in
the Northeast. When the group decided to sell and made
her a generous financial offer, Klostermeier and her new
husband headed west.
As successful as her journey has been, one aspect still
proves frustrating: the continued absence of women in
the highest ranks of the healthcare industry. Klostermeier acknowledges that the majority of chief nursing
officers are female, though. “The other positions—CFO,
COO, CEO—are few and far between for women,” she
says. “There are over 5,600 hospitals across the United
States, yet it’s difficult to find many women in C-suites,
especially when you get to the big systems. Even where
I’m at right now . . . it’s a single hospital. Would I have this
much success in a system? I don’t know.”
While Klostermeier feels it may be at least partly
attributable to a generational shift—e.g., women choosing to raise children later in life, putting healthcare
career growth on the back burner—she believes C-suite
opportunities are there if women make the effort to get
noticed in their day-to-day work. “You have to risk being
assertive,” she says. “Networking is a must, particularly
through organizations like the American College of
Healthcare Executives. You need to serve on committees
and serve on boards if you can.”
But more than anything, she stresses the importance
of women learning all they can from those above them,
regardless of gender. “I’ve had some amazing CEOs mentoring me along the way,” Klostermeier says. “There are
harsh ones out there that can damage one’s self-esteem
and career track, but if you find one that respects you—
and I’ve found several—you’ve got it made.” AHL

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Power Service
A former nuclear technician, Jason Atkins leverages technology in a different field today,
improving nurses’ decision-making, patient education, and quality of care at Emory Healthcare

AHL APR.MAY.JUN 2017

By Amanda Garcia

58

Like many students, Jason Atkins didn’t
have a well-formulated plan when he
graduated high school. But instead of
taking a year off to explore his options,
Atkins decided to work with nuclear
reactors. He entered the navy’s nuclear program as an
electronics technician and was immersed in rigorous
education for a little more than two years.
By the end of his training, Atkins’s appetite for learning was insatiable and further pushed him to complete
his formal education. He was accepted into a program
through a navy nursing Reserve Officers’ Training Course
(ROTC) scholarship and found his calling as a registered
nurse in a navy critical care unit in San Diego.
Even in those early experiences, Atkins was more than
impressed by the impact of technology, and even more so
with its untapped potential. He was inspired to discover
how technology could expand and improve patient care,
particularly in the realm of medical and nursing informatics, so he went on to get a master’s degree in biomedical informatics and further merge his interests in
healthcare and technology.
These days, Atkins’s natural ability to evaluate technology and its impact on clinical care remains a major
asset in his work as chief nursing information officer at
Emory Healthcare. His work naturally corresponds with
Emory’s CMIO—his counterpart, who focuses on physician workflow—and they both work closely with the CIO,
who is responsible for IT architecture and infrastructure. Collaboration is key between the three leaders as
they work to understand the complete technology environment at Emory.
“We know that one of us can’t change a single thing
without a downstream impact,” Atkins says.
But Atkins’s role as chief nursing information officer
is unique because he is responsible for meeting the
technology needs of the largest workforce in the organization: nurses. And because healthcare regulatory and
legal requirements continue to expand, nurses are not

JASON ATKINS
Chief Nursing
Information Officer
Emory Healthcare

only tasked with the responsibility of providing care to
their patients, but now they also have the added burden
of using technology to record and coordinate care and
manage information flows.
These new challenges have created endless opportunities for Atkins and his team. “One of my main focus areas
is figuring out how to reduce the burden of documentation and manual transcription for nurses and improve
communication between care team members,” he says.
It’s a big job, but the team has made substantial strides
in the nearly three years that Atkins has been in this
role. They’ve automated the medical administration
process to improve medication administration safety, for
example, and they’re currently working on the ability to
pull information from infusion pumps and automatically
transcribe it to patients’ EMRs.
“We’re always looking at which medical devices
are creating data that needs to be transcribed into the
medical record and figuring out how it can be automatically added to the EMR,” he says.
The nursing informatics team that makes all of this
happen at Emory is surprisingly lean and includes only
three nursing informatics specialists in addition to
Atkins. They work closely with the IT department to
evaluate, test, and focus on the technology itself. But
when Atkins joined Emory, he not only brought his skill
for technology, but also his passion for education.
“I’ve built an education team of nursing informatics
educators,” Atkins says. “It’s made of five nurses with a
variety of backgrounds and experiences, and they compliment the IT specialists by learning the technology and
teaching it to other nurses.” These educators teach in
classroom or web-based training settings, or occasionally
as a unit-based service to increase nurses’ confidence in
decision-making.
Conversely, these educators also work with clinicians to identify needed changes in existing technology,
which they then feed back to Atkins and the informatics specialists. This valuable information has required
marketing the education team as approachable and

LIFE

“Nurses are the key to
teaching individuals what
healthcare should look like
and how to navigate patientcentered, needs-oriented care.”
accessible and making them widely visible across the
organization. “They all practice clinical care directly one
day a week, and the rest of the time they preach what they
practice,” he says.
Taking education a step further, Atkins is equally passionate about teaching patients about their own health
and care options. Informing patients about the disease
process, medication dosage, and appropriate times to
take the next steps are crucial components of moving
from service-based to value-based care.
This transition has also shifted the focus to keeping
patients healthy and decreasing visits to the care team,
thereby moving the greatest inherent risk to that longer
time between care encounters. This extended time puts
more responsibility on the patients themselves and
requires them to know more information.
And who are the conduits of such information? The
answer, of course, is nurses. “They are the key to teaching individuals what healthcare should look like and
how to navigate patient-centered, needs-oriented care,”
says Atkins, who looks to nurses as a necessary lubricant
of integrated workflows. Not only do nurses spend the
most time interacting with the patient, but they are also
responsible for communicating about the patient with
service providers.
“Because of that, nurses will help us cross this transition of care in a safer, more holistic way,” Atkins notes.
This passion for serving others has grounded him
throughout his career and has manifested in a highly
collaborative, team-centric leadership style. “Whether
it is your country, your patients, or the job of the person
taking care of the patient,” Atkins says, “service is what
it’s all about.” AHL

Congratulations Jason Atkins, Emory University Hospital’s Chief Nursing Informatics Officer, on this well-deserved recognition. Welch Allyn is proud to
support your organization and help you better serve your patients and communities. Visit us at www.welchallyn.com to learn how we help healthcare
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59

LIFE

Prescription
for
Success
AHL APR.MAY.JUN 2017

How several healthy doses of reality in
the healthcare industry helped
T.J. Griffin keep PharMerica on the fast
track for growth

60

By Chris Gigley

LIFE

T.J. GRIFFIN
Chief Pharmacy
Officer
PharMerica

“I want to make sure
medication therapy is
not a reason patients
have to stop what
they’re doing.”
his father-in-law fell into a coma for six weeks and passed
away after one day of lucidity. Then, in 2013, Griffin lost
his father to complications from throat cancer.
“[My father] was in and out of nursing facilities, as
well,” Griffin says. “The first one where I visited him, I
looked at his chart and the IV hanging there and realized it was the wrong one. It was an underdose for my
father. I was more worried about the other patient, who
had double the dose he required.”
Those family experiences are never too far from
Griffin’s mind. Knowing how much work and pressure
nursing facility staff face pushes him to ensure the
utmost accuracy on every dose PharMerica pharmacies produce. “Our customers rely on us, and we want to
limit medication reconciliation issues, which data links
to higher costs and higher hospital re-admissions,” he
says. “I want to make sure medication therapy is not a
reason they have to stop what they’re doing.”
PharMerica currently has ninety-three pharmacies
in forty-six states and a team of about 3,000 employees,
including about 200 consultant pharmacists who review
all aspects of every patient’s medical chart and therapy.
“Our culture is one of care, commitment, and collaboration, which means best-in-class patient care and a
deep commitment to our clients’ success. On top of all
the daily dispensing our pharmacies do, we’re hands-on
in helping nursing homes stay regulatory compliant,”
Griffin says.
Monitoring compliance in forty-six different states
isn’t easy, he explains. To manage it, he receives daily
legislative updates through e-mail. “They’re not always
about law changes, but I know what’s being talked about
as a potential law or regulatory rule changes,” he says.
And, in each state, a PharMerica pharmacy director serves as the point person with the state board of
pharmacy, attending quarterly meetings and gathering
information. The company also has its own compliance
department that tracks changes in nursing home law.
“We’re active in making sure we can be a voice with
our nursing home partners if there’s a change in how they
operate,” Griffin says. “We want to be a voice with them to

AHLMAGAZINE.COM

T.J. Griffin has an especially unique
level of insight into the impact of his
work. He knows it makes a difference
because he grew up watching it in action.
The chief pharmacy officer of Louisville,
Kentucky-based pharmacy services company PharMerica has seen his own family rely on acute caregivers and
the medicines they provide.
Not only were science and math Griffin’s two best subjects growing up, but he also dated the daughter of the
pharmacist in his small Illinois hometown. “I got to know
him and his business and how respected he was in the
community,” Griffin recalls. “He was really a caretaker
of the community. We ended up getting along better than
his daughter and I did.”
Griffin knew he wanted to work in healthcare at an
early age, but he didn’t decide on pharmacy school
until after his family went through several healthrelated hardships. The first was the paralysis of Griffin’s
grandfather. Given just six months to live due to ensuing
complications, he lived another six years instead. Griffin’s grandmother became the primary caregiver and a
regular customer at the local pharmacy. Griffin remembers her story about two pharmacists there who essentially saved his grandfather’s life.
“My grandfather was always in pain, and these pharmacists kept making him stronger medication to the
point where they couldn’t make it any stronger,” Griffin
says. “They knew something wasn’t right, put two and
two together, and found out that the nurse was watering
down the pain medicine.”
That story showed him how vital pharmacists were,
and after high school, he enrolled in pharmacy school
at the University of Iowa. After graduating, he moved to
Florida to take a job with Eckerd, the same company for
which the two pharmacists had worked.
“As I progressed through that company, I would tell
that story of the two pharmacists to folks who worked
with me,” Griffin says. “You need to go back and get to
know your customers. There was a reason my grandmother needed help. There’s more to the story.”
Griffin spent thirteen years at Eckerd, until another
family trauma redirected his career path. Within a week
of discovering his mother-in-law was seriously ill in
2003, he got a call from PharMerica.
“To tell the truth, I didn’t know what a long-term care
pharmacy was at the time,” he says. “I had the interview
and felt like it was divine intervention to be able to bring
my wife and son to be near my mother-in-law. I got a full
education right away on hospice care and how caring and
loving long-term and hospice care nurses are. They’re
really the unsung heroes of medicine.”
Griffin’s mother-in-law passed away months after he
joined PharMerica, but unfortunately, he wasn’t done
getting a firsthand look at long-term acute care. In 2006,

61

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LIFE

make sure rules and regulations make sense
and don’t inadvertently affect our ability to
have good patient outcomes.”
To manage all this work effectively, Griffin
surrounds himself with a knowledgeable
team that share responsibilities. PharMerica has thirteen regional pharmacy directors
and three VPs of operation who oversee anywhere from five to eight pharmacies each.
“There’s no way you can do a good job if
you’re overseeing thirty pharmacies, filling
as many prescriptions as we do,” Griffin says.
“We have over one hundred separate clinical
and service metrics we monitor to ensure we
can provide best in class care and service.”
Griffin’s latest focus is the company’s antimicrobial stewardship program, which is an
effort to stop the spread of drug-resistant
super viruses that are becoming alarmingly
more common.
“Hospitals have had these types of programs for years. Now that nursing homes
are becoming more like mini-hospitals, they
need these programs, too,” he says.
Griffin says that he wants his team to
measure the use of antimicrobials to extend
their effectiveness. “You have got to select
the optimal drug regimen for the right outcomes,” he notes. “You can’t just throw
big-gun antibiotics at a microbe that may
still not be resistant to a first-line therapy.”
Soon, Griffin explains, those antibiotics
won’t work anymore, allowing that microbe
to spread. For the type of end-consumer
PharMerica most often serves, the elderly,
this outcome is particularly ominous. “Our
role is to focus on diagnosis, communicating among the healthcare providers, nursing
facilities, and pharmacists,” Griffin says.
“Then, it’s selecting the right drug, the proper
dosing, and proper duration. We create an
accountability structure.”
Education, either on-site or via PharMerica’s online portal, is another key aspect of
the program, Griffin explains. He knows
better than most that it’s better to learn
that way than by experiencing problems
firsthand. Griffin has been through it, and
because of that, he hopes that fewer people
will in the future. AHL
“TJ Griffin and Pharmerica have affirmed a commitment
to proactively identify and manage medication risks, which
comprise over 37% of the adverse events affecting the
industry. Pro-GeneX and Pharmerica are proud to work
together in bringing the advantages of personalized medication risk management to entire long term care patient
populations.”

Charting a Better
Course in North America
After leaving Soviet Ukraine at twenty-six, Tetyana Buescher rode her momentum
all the way to her current position as general counsel for CompuGroup Medical
By Kathryn Silverstein

TETYANA
BUESCHER
General Counsel
CompuGroup
Medical

maintaining compliance with healthcare legislation, such
as the Health Insurance Portability and Accountability
Act, is roughly 40 percent of her job. She understands
the need to wade carefully through regulations, which
is where her experience in the financial services industry becomes so valuable. “Sometimes business needs
clash with regulatory needs and create huge expenses
for companies,” she says. “What has been happening in
healthcare is that smaller players are being pushed out of
the market or bought up by larger companies due in large
part to the expense of ongoing compliance.”
Buescher explains that while a small business could
potentially provide a better and more nimble service
or ideas, the regulatory field raises the bar to entry and

“My grandmother could not
even read, and here I am, a first
generation immigrant with an
executive position in a global
healthcare company.”

AHLMAGAZINE.COM

As Tetyana Buescher reflects on her
journey thus far, she admits that sometimes it’s hard to believe all the twists
and turns her life has taken. “My grandmother could not even read, my parents
never had a college degree, and here I am, a first generation immigrant with a JD degree and an executive position in a global healthcare company, advising on legal
affairs in North America,” says the general counsel for
CompuGroup Medical about her unique background.
Buescher, a former in-house lawyer in the financial
services industry, moved to the United States at the age
of twenty-six from Ukraine, where she grew up in an
average family as the daughter of a factory worker and a
government clerk. “Soviet Ukraine was a whole different
reality, where a girl like me would never even dream to
be what I am now,” she says.
In her current role, Buescher is a key member of the
business team, wearing both business and legal hats.
“Sometimes there are days when I don’t do anything
particularly legal,” she explains. However, this arrangement makes more sense given the host of regulations
that her company must comply with in order to produce
cutting-edge healthcare technology solutions. “The presence of a lawyer is necessary to ensure a new product
is in compliance during the design and concept phase,
which can save time and effort down the road,” she says.
“I know from the get-go whether or not a new idea will
work from a regulatory standpoint.”
This legal advice is critical in the increasingly regulated healthcare industry. Buescher estimates that

63

LIFE

Sherin and Lodgen
joins American
Healthcare Leader
in congratulating

Tetyana Buescher
on her outstanding
accomplishments as
General Counsel of
CompuGroup Medical.

Sherin and Logen LLP

Complex Law. Clear Guidance

AHL APR.MAY.JUN 2017

Real Estate | Litigation | Business Law

64

www.sherin.com

development in the healthcare
marketplace. CompuGroup is in a
unique position, being a small association with a start-up mentality
backed by a larger company based in
Germany. This allows CompuGroup
GIVING THANKS FOR
to develop and bring new products
HELP ALONG THE WAY
into the market in a highly reguBuescher credits strong mentors
lated industry. However, this can
for helping her throughout
present unique challenges to the
her career, starting with her
small, two-person legal team that
contracts professor and now
Buescher heads, due to the need to
dear friend Jennifer Martin, who
keep costs down and also compete
hired her as a research assistant
during law school and coached
with larger corporations.
and raised her confidence as
Buescher’s position is uniquely
a young attorney. She also
challenging as well, because she
credits Liz Levy, now an attorney
must proceed with a heightened
at MIT, who was her mentor
cultural awareness when collabothrough National Association of
rating with her colleagues in other
Women Lawyers and who also
became a close friend. “Both
countries. It’s her experience from
Liz and Jennifer did so much
adapting to the cultural differences
for my confidence level and
between her native Ukraine and
professionalism,” Buescher says.
the United States, though, that has
been critical in helping Buescher
Her list of mentors would not
navigate these potentially turbube complete without mentioning
Byron S. Kalogerou, a partner
lent waters. “Being from a different
at McDermott Will & Emery LLP
culture makes it easier for me to
who lent his time and expertise
adapt. I learned a new culture once;
in a mentoring role, as well
I can learn it again,” she explains.
as her current boss, Werner
“Moving to a different field or
Rodorff. “Werner is an amazing
role, or working within a different
human being,” Buescher says.
“He put a lot of confidence and
environment, demands adaptabiltrust in me, and I appreciate it
ity. I am actually excited to learn
very much.”
new angles to look at things, new
approaches, and new mindsets.
That is a trait that has been the most
important to my career.”
Her perspective on healthcare business and culture is
heavily informed by her understanding of its regulations.
She found the same to be true when it came to understanding American culture through its legal system.
“Learning procedure and Constitutional law made me
see American history in a different light. It helped me
figure out American culture,” Buescher says. “Coming
from a country with a communist regime that fell when I
was fourteen, and seeing how the system here works and
how great it is, I have a greater understanding of what
makes this country special. It gives me a sense of pride
living my American dream.”
One of her personal goals is to give back to the community that helped her find her place and lead a successful career in law. “I benefited greatly, and I want to give
back,” she says. “I am humbled and grateful for the opportunity to mentor women in the professional workspace
through a formal mentorship program at CompuGroup.
I also want to come back to the National Association of
Women Lawyers program and offer mentor services now
that I’m more advanced in my career.” AHL

A New Set of Orders
Erlanger CIO David Peterson details his journey from the navy to civilian medicine

AHL APR.MAY.JUN 2017

By David Baez

66

Tennessee-based Erlanger Health
System—the seventh largest public
healthcare system in the United States—
attacks new IT projects, such as the
recently underway EMR install, with an
extra dose of discipline. That’s probably due to the company’s chief information officer David Peterson and his
military background.
For more than twenty years, Peterson served Navy
Medicine as a medical service corps officer, initially
as an administrator overseeing medical records and
managed care. He then helmed a multimillion-dollar IT
deployment project stateside, as well as in the European
theater, moving on to do the same for the Marine Corps
supported by Navy Medicine. Finally, he earned a spot
as CIO for the National Naval Medical Center, known as
“The President’s Hospital.” In 2001, he retired from the
navy and embarked on a civilian career.
But while Peterson won’t discount the influence that
the military’s culture of discipline and regimentation
had on him or deny that it migrated to his civilian work,
he is quick to point out that, when it comes to medicine,
there are vastly more similarities than differences in the
two sectors. “Military medicine is medicine,” Peterson
says. “With operational warfare, it’s a much more regimented environment. But in hospitals and clinics, it’s all
about the patient’s care. You could have a navy captain
physician treating an enlisted sailor in that bed, and it’s
a patient-physician relationship.”
Peterson approached the transition thoughtfully and
carefully, making sure that the work he took on allowed
for a clean transfer of skill sets. While he transitioned
from being a military officer in khakis to wearing a suit
and tie for the University of Maryland Medical System,
Peterson says it was essentially the same job. “The only
difference was getting to work at eight o’clock, whereas
at the National Naval Medical Center, I was attending
Admiral’s Call at six thirty,” he says. “I still had to deal
with providers, patients, and their families. Actually,
the hardest part of the transition was deciding which
tie went with which suit.”

After working for several different health systems and
running a consulting firm, Peterson joined Erlanger in
September 2015 as senior VP and CIO. He calls himself
a “turnaround CIO” who has expertise in stabilizing
IT departments that need guidance. To that end, he
maintains an open-door policy with staff and lets
everyone, whether it’s a director or an analyst, know that
they are involved in all decisions. This includes going to
various members of the staff and asking what they think
about pressing projects before presenting the idea to his
leadership team.
“You get the most out of people when you treat them
with respect,” he says. “I was like that in the navy, too.
Even though I was an officer, I never used my rank to get
something done. It was always a team approach.”
Peterson views IT as an intimate part of the caregiving
process, rather than a detached unit. He sees the relationship between IT and clinicians as a partnership.
At the end of every monthly IT staff meeting, Peterson
reminds his staff that although they are not caregivers,
per se, they play an important role in the patient care
process. “We support the tools we give the clinicians
to help patients,” he says. “In that way, we help provide
care for the patients, and we can hold our heads up high.
I never talk about IT in general. Everything is always in
the context of overall clinical and business strategy.”
Peterson and his staff have completed roughly 30
percent of an Epic EMR install. Once the project is
complete, records that used to require accessing multiple systems will be streamlined into one. A doctor or a
provider will be able to follow the entire continuum of a
patient’s care in one record, thus giving a clearer picture
of a patient and saving healthcare professionals enormous amounts of time and effort.
In the end, all of this effort benefits the patient at the
hospital. Peterson believes that information technology
has radically transformed the patient experience overall,
not only by increasing efficiency on the operational level,
but also in terms of the amount of health information
that is now so readily available.
“It’s opened the eyes of the consumer,” he says. “The

DAVID PETERSON
CIO, Senior VP
Erlanger Health
System

LIFE

“You get the most out of
people when you treat
them with respect. I
was like that in the
navy, too.”

AHLMAGAZINE.COM

patient has become a player in their
care through access to medical
records and all the information
on the Internet. They come into a
doctor’s office fully prepared, with
different options of treatment. Providers have to be careful. A small
community hospital could be competing against clinical research data
downloaded from Johns Hopkins,
and the patient might second-guess
that physician.”
Peterson is one of seven senior
executives on Erlanger Health
System’s senior executive team, an
indication of the degree of respect
IT is granted within the system.
Whether it’s clinical initiatives
or the acquisition of a new physician practice, the other executives
always look to IT as an important
player in integration, Peterson says.
“If they want to go somewhere and
I can’t support it technically, there
will obviously be a problem getting
there,” he explains. “With quality
initiatives and financial goals, we
have to provide them with what they
need to be successful.”
As he drives the organization
forward, Peterson depends greatly
on the lessons he learned in the military, not the least of which is that,
though contexts may differ, medicine is always medicine. “The environment might change,” he says. “A
civilian hospital is different than
a wartime environment with jets
flying off the carriers. But at the end
of the day, medicine is always about
the patient.” AHL

67

LIFE

A Patient’s Perspective
CFO Bill Fenske draws on his own childhood experiences as a patient to care for Rice Memorial Hospital

AHL APR.MAY.JUN 2017

By Matt Alderton

68

Growing up in southwest Minnesota,
Bill Fenske spent a lot of time in and out of
hospitals. So, the fact that he has worked
in them for the last twenty-five years is
no accident.
“I was a healthcare user as a child due to a birth defect,”
says Fenske, now CFO at Rice Memorial Hospital, a Level
III trauma center in Willmar, Minnesota. “I had a lot of
surgical procedures that were really scary and really
painful. They were not pleasant experiences.”
His early encounters with medical care made an
impression on Fenske. When combined with a lifelong
penchant for numbers and statistics that he inherited
from his father, a math teacher, Fenske found himself
drawn to healthcare administration as a young accountant. “I got my degree in accounting and started working
for a public accounting firm that audited hospitals,” he
explains. “I needed to leave public accounting in order to
get my MBA, so I moved into a different part of healthcare and worked at a clinic for three years while I went to
night school at the University of Minnesota. After that, I
started looking at CFO jobs in hospitals.”
As Fenske would soon learn, the role ended up being a
perfect fit. “It wasn’t conscious, but healthcare was a part
of me because of my childhood,” Fenske says. “I really
believe that we all have a calling in life, and that it’s our
responsibility as human beings to find that calling. I was
fortunate enough to find mine early on in my career.”
Although he doesn’t care for patients directly,
Fenske’s job—ensuring that Rice Memorial Hospital

BILL FENSKE
CFO
Rice Memorial
Hospital

can deliver the best possible care at the lowest possible
cost—impacts them profoundly. “Finance is critically
important to healthcare because at the end of the day,
if you don’t have the money to pay your employees and
your bills, you can’t provide the service,” Fenske says.
He describes part of the CFO’s job as keeping a hospital
steady in perpetually choppy waters.
“One of the biggest things a CFO can do—and what I’m
proud that we’ve accomplished here—is set a vision for
how to enhance the financial strength and viability of the
hospital by developing long-range financial plans that
strengthen the organization and allow it to implement
its strategy,” he says.
At Rice Memorial Hospital, the largest municipally
owned hospital in Minnesota, those long-range plans
have focused on improving productivity, which also
allows the hospital to deliver more care with fewer
resources. These initiatives have also focused on leveraging assets to lower its long-term debt-to-capital ratio
and increasing its cash reserves, which Fenske has grown
from a thirty-day supply of operating expenses to a nearly
125-day supply.
However, it’s not only financial strategies that have
made Rice stronger; it’s also the way that Fenske has
implemented them. “Most people in healthcare have
numerous degrees, so we’re all inclined to think academically. I use an academic approach to teach people
what our financial best practices are, utilizing examples
to help them understand why they’re our best practices
and why it is that we need to utilize them,” he explains.

LIFE

Celebrating

“I remember from when
I was a child how scary the
hospital was, so it’s really
important to me that I
empathize with patients.”

Fenske focuses heavily on making intricate financial
concepts relatable.
“Something I learned many years ago is that you need
to express finance in terms of what it means to individual
departments by utilizing terminology and examples that
are relevant to their area of focus,” he says. “That’s the
biggest reason why CFOs are not successful—because
they’re not able to relate to each department within the
business and understand what their unique needs are.”
One aspect that’s weighing especially heavily on
several departments at Rice Memorial Hospital is the
Affordable Care Act and the many changes it continues
to bear, including revenue-cycle management, which
Fenske has approached aggressively in response to
healthcare reform. “Pulling out all of the legal reimbursement that we are entitled to based on the services
we provide has brought a lot of strength to our balance
sheet, which will help us get through these rocky times
that we have in front of us,” he says.
At the end of the day, however, what stays at the forefront for Fenske isn’t accounting strategies, it’s patients.
“I remember from when I was a child how scary the hospital was, so it’s really important to me that I empathize
with patients who are experiencing that feeling now
when they come to our facility for services,” he says.
“Whether that’s reassuring a patient that their services
will be covered by insurance or helping them find another
mechanism to pay for their care, I’m in a position to help
them alleviate some of their worries so they can focus on
getting well.” AHL

Laying Down the Law
in Cook County
Gina Knox helps protect Little Company of Mary Hospital with strong responses to
litigation and extensive internal education

AHL APR.MAY.JUN 2017

By Jeff Silver | Photos by Kristin Deitrich

72

When Gina Knox went to law school,
she was looking to expand beyond the
patient-care responsibilities of her role
as a registered nurse at Evanston North
Shore Hospital. The job she ultimately
landed probably exceeded what she might have imagined at the time. As general counsel at Little Company
of Mary Hospital (LCMH) in Evergreen Park, Illinois,
much of Knox’s time is devoted to litigation strategy and
risk management in the highly litigious environment of
Cook County.
The county, which has no tort caps, has recently experienced a significant rise in the number of claims filed
and other legal actions taken, along with a similarly
large spike in the amount of verdict values—as high as
$53 million.
It also operates with some unique statutes, such as
interest that is attached to pending appeals, which adds
to the cost and complexity of defending cases.
In light of this, Knox and LCMH take a proactive
stance in responding to legal actions and addressing
risk management with a thorough review of claims and
education throughout the hospital. “It can be costly

to mount a defense, but if you don’t put up a fight, you
simply attract more of the same—much of which is inappropriate manipulation of the system for financial gain,”
she says.
Knox and her team execute risk assessments and
ensure that appropriate policies are in place to guide
processes and decision-making at all levels of medical,
support, and administrative staff. This can involve
everything from reconciling apparent conflicts between
various Joint Commission and Illinois Department of
Public Health regulations to determining when onpremises recordings using smartphones and even police
body cams is allowed.
While addressing and clarifying these issues, Knox
initiates related educational programs for the appropriate staff and departments. Recent sessions have covered
global standards of care and scenarios related to emancipated minors, informed consent, and appropriate procedures for DUI blood draws. Although typically driven by
standard-of-care information, there have been instances
when outside litigators and physicians have also been
brought in to speak about issues involving risk prevention and management.

IMPACT

AHLMAGAZINE.COM

GINA KNOX
General Counsel
Little Company
of Mary Hospital

73

IMPACT

STAT SHEET: LITTLE COMPANY
OF MARY HOSPITAL

298

licensed beds

601

professional staff

2,109

employees

531

AHL APR.MAY.JUN 2017

nurses

74

“I often ask groups to submit specific questions they
have ahead of time so we can address them directly,”
Knox says. “That helps avoid hypothetical situations
and later having staff trying to make real-world decisions based on more general information we might have
presented. We always want them to have specific details
and to err on the side of caution.”
Knox works tirelessly to ensure that the legal office is
exceptionally accessible to everyone. Previously located
on a remote floor before the hospital moved into its new
building less than four years ago, the office is now in the
same location as the rest of the hospital administration,
which facilitates ongoing communication with key
executives. She also encourages an open-door policy for
anyone who may need advice.
“I want staff to feel free to come see me or consult
with my office and to know that we’re accessible 24-7,”
she explains. “That approach helps build personal relationships and demonstrates that we’re really part of
the team. It helps create an environment in which staff
welcomes our input instead of dreading when they see
‘the lawyers’ coming.”
To help establish sound relationships quickly, Knox
is part of LCMH’s onboarding program for new physicians. She believes that meeting them “when things are
good, not just when there’s a potential problem” goes a
long way toward creating personal and more productive
connections. Physicians who have met her through the
program have, in fact, tended to be more proactive in consulting her and her office via texts and informally visiting
the legal office.
In the thirteen years since Knox began working at
LCMH, her philosophy of “self-education” has enabled
her to keep up with the many changes that have occurred
in healthcare practice, policies, governance, and regula-

200,000

approximate number of babies delivered

1930

founding year of first hospital

tion. For Knox, that process has included reaching out to
colleagues and teammates and being mentored by Patricia Foltz of Anderson, Rasor & Partners. It’s helped her
address issues that usually aren’t taught in law school,
such as how to handle a recalled product that the manufacturer wants returned, but that is still considered
evidence in an ongoing lawsuit.
Knox maintains an extended network that includes
LISTSERVs and formal education, helping her to keep
up with important legal developments and trends. It also
provides her with valuable decision-making resources.
“You might have all the information, but still need to talk
it through with someone else to confirm that you have the
answer,” she says. And when someone else needs assistance? “It’s a good thing if you can reach out to ask for
help. It doesn’t bother me if you don’t know the answer.
It bothers me if you don’t know how to ask.”
Through all her litigation, education, and risk management efforts, Knox attests that there is no such thing as a
former nurse: “I’m really very protective of the hospital
and the entire team.” AHL
Anderson, Rasor & Partners, LLP’s attorneys have represented Little Company of Mary and many other Chicagoland hospitals and healthcare professionals in litigation matters, preventative and healthcare legal counseling,
and medical staff matters for over thirty years. We help our clients make a
difference and we make a difference to our clients.

Neighbors
Helping
Neighbors
Lakewood Health CEO Tim Rice uses a grassroots approach to running the healthcare system, while at the same time
propelling his mission to provide quality, personalized care in rural Minnesota

AHL APR.MAY.JUN 2017

By Stephanie S. Beecher

76

In the pastoral townships surrounding Staples, Minnesota, residents are
known to talk. Although some may brush
off this spiel as typical small-town conversation, Tim Rice is more likely to lean
in and listen. As the CEO of Lakewood Health System,
Rice is supremely aware of how his decisions affect his
neighbors, as he uses his unique vantage to gauge the
quality of healthcare in his community. Then, he looks
for ways to improve it.
“Being in a rural community, you really live under a
microscope,” says Rice, who has worked for Lakewood
Health System for more than thirty-five years. “You
might make a decision and have to sit next to the person it
affects the next day at the school or at church. As a leader
in a small community, there are significant obligations.
How do we get the right quality at the right price? We
should always be pursuing the opportunity to improve
the healthcare that is offered.”
Founded in 1936, Lakewood Health System is an integrated health provider with a twenty-five-bed critical
access hospital in Staples and five primary care clinics
throughout the region. In addition, the health system
offers women’s specialty services, senior services, surgical, and outreach care. With a regional population of

no more than 15,000 residents, Lakewood doesn’t exactly
have all the moving pieces of the country’s metropolitan
healthcare organizations. However, running a rural facility still has its unique challenges, Rice explains.
“We work to provide all the services we can here,” he
adds. “But it must be able to be done well. If we cannot do
it well, we do not do it at all. Quality takes priority over
money. Certain things can occur—like physicians leaving
or major reimbursement changes—that can have a major
impact on the operations and viability of an organization. One VP might run four departments. Employees and
management must also multitask their work, so you learn
to be flexible and adapt.”
Rice doesn’t moonlight as a surgeon, of course, but it
isn’t exactly a stretch to say that he’s spent some time
in the operating room. In fact, after leaving his family
farm for college in the 1970s, he went to work as CFO at
a small county hospital, where he was exposed to a wide
spectrum in the healthcare field.
Rice was taken under the wing of the hospital’s CEO
and chief of staff, who regularly pulled him into surgery.
“The chief of staff said, ‘You’re going to learn medicine,’”
Rice recalls. “He had me exposed to all kinds of procedures. He wanted me to understand the patient side of
things. I had such support from him because they let me

TIM RICE
President, CEO
Lakewood Health
System

IMPACT

“If you do the right things for
people, they will come to you.
Word of mouth means people
will select our organization.”
people are using hospital and clinic services,” he says.
“You may look at it as eliminating hospital stays, but if
we’re effectively providing care, isn’t that what we’re
supposed to be doing? An organization has to adapt and
learn how doing the right thing impacts them from an
operational perspective. It is so important to reduce our
overall cost of care and make patients healthier. We are
passionate about the triple aim and improving value
whenever and wherever we can.”
It’s all about the pursuit of the greater good, Rice
says. This attitude is the reason that Lakewood Health
System has partnered with its competitors and regional
agencies to improve health throughout the region. They

AHLMAGAZINE.COM

learn and got me started on the right foot. I owe a lot of
gratitude to the physicians and administrators there.”
His experience at the county hospital left a mark, and
when Rice left for Lakewood Health in 1977, he made
it his mission to make a difference. “Being independent and not in a system, it allows us to make decisions
pretty quickly,” Rice says. “We do a lot of grassroots type
of activities, and all of that creates buy-in. Working on
improving health is one of them.”
Recently, Lakewood Health invested in a new EHR
and entered an agreement with an ACO, which allows
Lakewood to legally obtain information on its Medicare
patients. The arrangement gives Lakewood the ability
to collect important data and insight into its quality of
care. “We can get cost and utilization information and
find out how we are doing in comparison to others,” he
explains, adding that the program also links coordinators
to patients to oversee their care and health.
For example, a community paramedic might make a
home visit to a resident who has been constantly landing
in the emergency room, only to find out they are living
without electricity, or that some other issue is adversely
affecting their health. Once the problem is identified, the
Lakewood team can find ways to help.
“This approach looks at all of the elements of why

work jointly on addressing topics such as
community health collaborations, promoting healthy lifestyles, food insecurity, and
maternal and infant care.
“I want all of our competitors to be exceptional,” Rice says. “If my child got hurt, I
don’t know where my child might be. So even
though we compete, there are key things we
must pursue together for the well-being of
our patients and communities. I don’t want
our own organization to be a barrier to that.”
“If you do the right things for people, they
will come to you,” he adds. “Word of mouth
means people will select our organization.”
Rice works to create the same congeniality among his staff, as well. He regularly
meets with representatives from each
division to get input on ways to enrich
employee culture. And recently, he’s been
working with employees on strengthening its
mission statement.
“If it doesn’t connect to the heart of the
people who are doing the work, the vision
is not as effective as it can be,” he says. “We
want them to know we can really create connections and have a positive influence within
the community and in the workplace. And
you can really make a difference because it’s
like neighbors taking care of neighbors.” AHL
NXC Imaging is honored to be one of Lakewood Heath System’s trusted imaging partners. NXC Imaging proudly works
hand in hand with hospitals and clinics to provide state-ofthe-art radiographic equipment. We’ve partnered with Lakewood Health System to provide innovative diagnostic tools
that can handle the most advanced imaging needs. We look
forward to a continued collaboration with Lakewood Health
System to help provide quality healthcare to the community
it serves.

AHL APR.MAY.JUN 2017

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78

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Investing in People,
Not Policies
Nebraska Medicine’s Frank Venuto is on a mission to make HR a strategic business
partner by linking the investment made in employees to the organization’s ability to
provide exceptional healthcare
By Stephanie S. Beecher

Offering quality patient care combined with research and education,
Nebraska Medicine has become one of
the most esteemed medical centers in its
region. With the clinical integration of the
Nebraska Medical Center, Bellevue Medical Center, and
UNMC Physicians, the organization provides access to
more than 1,000 physicians and 676 licensed hospital
beds, all exemplifying the promise of “Serious Medicine.
Extraordinary Care.” In order to maintain this high standard, chief human capital officer Frank Venuto works to
keep waste out of the formula and ensure the talented
workforce feels supported and valued.
Your official title is chief human capital officer. What
do those words mean to you?
Frank Venuto: Using the term “human capital” reflects
an innovative way of thinking about your workforce.
What makes any company flourish is its people and the
collective genius they bring; they make an organization
come alive and have either a positive or negative impact
on patients. There is no replacement for high-accountable talent, and it should be treated as any other business
asset. To grow as a healthcare system, you must invest in
your people, just like you would for other priorities, such
as infrastructure or technology. By making an investment
in employees, you not only ensure that their skills are
specialized, so that they can take the best possible care of
patients, but you also send them an important message—
that they are valued, cared about, and supported.

Dave Hynek

Venuto: Decades ago, HR fulfilled more of an administrative function. It was tactical, less solutions-oriented,
and revolved more around policy rather than functioning

as the strategic business partner it has become today. I
would say that Nebraska Medicine’s HR is more connected to operations now than it has been in the past.
We deliver a strategic orientation to our work, assessing whether our policies, practices, and culture of today
will hinder or aid in moving our organization into the
future, and we course-correct accordingly. By making
sure that we are delivering workforce solutions for both
our colleagues and management teams, we ensure that
the health system continues to deliver on our brand
promise of “Serious Medicine. Extraordinary Care.” We
are making great strides. One of our leaders told me that
one year ago, he never would have thought about having
HR at the table to discuss our business problems. Today,

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How does this perspective differ from traditional HR?

FRANK VENUTO
Chief Human
Capital Officer
Nebraska
Medicine

79

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IMPACT

he couldn’t think of why he wouldn’t. That’s the partnership we are after.
You mentioned that HR professionals previously
served in more administrative roles. How do you
position HR as a strategic player in the organization?
Venuto: The key is to demonstrate the value and return
for investing in your workforce and to communicate that
investment in the same business terms that organizational leaders consider for other strategy and operational
decisions. But HR’s reach is more than just demonstrating your business acumen. You have to partner with
your chief transformation officer and patient experience
officer to build a single corporate culture and a leadership
strategy to support it.
For example, we are currently focused on recruitment
and retention of top talent, especially as we are staffing
our new Fred & Pamela Buffett Cancer Center. We are
improving our entire selection process, from candidate
sourcing to one-year onboarding. We are simultaneously
working on reducing the cycle of our time-to-fill and
improving the retention of our first-year colleagues. We
expect to achieve significant savings in the cost of agency
labor, premium pay, and turnover, while improving the
quality of our hires. Importantly, this work bleeds into
managing our colleague experience and putting effort
and energy into our human capital, similar to the way we
focus on our patient experience. Research shows that if
great employees leave their organization, it’s because of
their managers; high-accountable talent wants to work
with other high-accountable talent.
We are focusing on the development of our front
line and management talent while creating the proper
systems of accountability to maintain top talent. We have
to improve ourselves as an employer and position ourselves to compete for great healthcare talent.
In the healthcare industry, staffing remains a top
concern—especially as aging baby boomers demand
more care. How has Nebraska Medicine worked to
improve its employee relations?

Also, we are being proactive in listening to our
high-achieving employees through focus groups,
advisory councils, forums, and roundtables with senior
leadership. Because of their input, Nebraska Medicine
offers career development support that did not exist
twenty or thirty years ago. Nebraska Medicine has
grown through a series of mergers and integrations with
other healthcare organizations. One of the results of this
growth was a combination of various wage programs
that needed to be rationalized. The inequity was causing
great dissension among our colleagues and creating
distrust for our leadership.
Consequently, leadership agreed to address significant
compression issues and a three-year plan was developed
and communicated. We recently added $60 million to our
compensation program to ensure that every employee
is paid in accordance with their experience, education,
and performance. While the investment was significant
to reach market competitive rates, the larger message
was equally as important: our staff saw evidence that we
listened and acted, remaining true to our word. Since this
important investment, we’ve had less than a handful of
nurses turn down our offer due to pay and we’ve also seen
a reduction in our turnover.
What keeps you motivated as a healthcare leader?
Venuto: I am just like the majority of all employees—it’s
not just about a paycheck. I strongly believe in the vision
of Nebraska Medicine and its ability to positively impact
our patients, their families, and our community. That is
the same motivation that I hope to instill in our entire
workforce by showing that their work is meaningful and
their contributions are recognized and appreciated. If
you can touch the hearts and minds of your employees
and let each individual know that he or she is important
to your collective success, then ultimately our patients
will benefit. AHL

AHLMAGAZINE.COM

Venuto: We know that the makeup of our workforce is
evolving. Our employees span several generations and
each generation has unique needs. Nebraska Medicine
has to position itself to provide benefits and support that
meet employees at their current life stages. The average
age of our employees is mid-thirties, but those employees’ needs are significantly different from employees
in their sixties. We are focused on individualizing our
benefit offerings to cater to the priorities of our colleagues and educating them accordingly. This innovative
way of thinking makes us a better employer and better
place to work.

“If you can touch the hearts and
minds of your employees and let
each individual know that he or
she is important to your collective
success, then ultimately our
patients will benefit.”

81

IMPACT

IN

CARE
Janet Miller leads a legal department recognized
as one of the most innovative in the country to help
University Hospitals serve its community
By Amanda Garcia

AHL APR.MAY.JUN 2017

EVERY

82

When University Hospitals began
its search for a new general counsel
in 2001, it called an attorney who had
already become a valued legal partner
during her years as outside counsel. At
first, Janet Miller turned down the offer because she
was concerned the job wouldn’t allow her to continue
her work in the community. However, when the CEO
assured her that her commitment to that work was an
asset, Miller agreed to explore the option.
“During the interview process, the hospital personnel
kept emphasizing their organizational culture,” Miller
recalls. The hospital has always been vocal about its commitment to serving the community and being culturally
centered around quality, compassionate, state-of-the-art
care. “I thought it all sounded nice, but when I got here
and saw firsthand how they live it every day, I was convinced,” she says. That was more than fifteen years ago,
and Miller has never found a job more satisfying.
University Hospitals is one of the oldest organizations
in Cleveland. It was started by a group of civic-minded
women with the intent of providing care for those
who couldn’t afford it—particularly soldiers wounded
during the Civil War and workers who were injured
during the Industrial Revolution. During Word War I,
the original Lakeside Unit of doctors and nurses cared
for soldiers in France. The next generation of the unit
was stationed in Austria and cared for soldiers in World
War II in the Pacific regions. The children’s hospital of
University Hospital is 125 years old, and its MacDonald
Women’s Hospital is the only hospital in Ohio dedicated
to women’s health.
“We were started and supported by people who wanted
to care for their community,” Miller says. “All these years

CORNER
later, our strategies remain focused on that same goal.”
To support these strategies, Miller has structured her
law department around practice groups that focus on the
primary business areas of the organization. Attorneys
work closely with executive leadership, physicians, operations, finance, human resources, and other areas to build
collaborative expertise and new solutions. Lawyers learn
the business, and business leaders learn applicable legal
principles, empowering each to interact and work more
effectively. “As a lawyer, seeing the big picture is incredibly helpful but typically only happens if you’re working
in-house,” Miller says. “Recognizing that has made me a
better general counsel with my outside counsel, and I am
careful to keep them informed. Early on, we even invited
outside counsel to sit in on our department to learn our
business better.”
Putting University Hospital’s values of teamwork,
excellence, innovation, and compassion into action
every day is one reason why InsideCounsel named the
law department one of the top ten most innovative in the
United States in 2013. It received the award for developing a computerized system used by personnel to report
any incident at any hospital or physician office as soon as
it happens. “Knowing when an incident happens allows
us to address the issue immediately rather than wait
months or years if and when a claim arises,” she says. “We
want to address quality, safety, and care issues immediately.” The introduction of the program initially resulted
in an increase in incidents at the hospital because everything was being reported, but the immediacy of the information decreased the number of claims and lawsuits and
has saved the hospital more than $200 million to date
in litigation costs and increased the quality of care and
patient safety.

“We were started and supported by people who wanted
to care for their community. All these years later, our
strategies remain focused on that same goal.”
community,” she says. “We have a hospital in an Amish
community and have a member of the Amish community on that hospital board of directors.” This location
also has a parking lot with a buggy rail, and its maternity
ward has many midwives to accommodate traditional
Amish birthing needs. “Those are the kinds of things that
we take into account when we say we’re committed to
serving our communities,” Miller says.
University Hospitals also prioritizes diversity of staff,
vendors, and service providers as one of its five core
values. Miller is proud of the diversity of her legal team,
but acknowledges that it can be a challenge to find qualified candidates in healthcare law who are ethnically and
racially diverse. True to her nature, Miller has used this
particular challenge as another opportunity to innovate.
“Our interns here in Cleveland tend to be very diverse,

AHLMAGAZINE.COM

Transparency was vital for the success of this and
other programs, allowing personnel in each area to
analyze how the process could be improved. “Every incident—even if there was no harm—went back to its respective department to be addressed in order to improve the
quality of care,” she says. It is called the Lessons Learned
program and hinges on the expectation that teams would
not point fingers, but rather work together to solve problems. It built trust among teammates, which allowed
them the freedom to focus on providing excellent quality
care and finding creative solutions. “It has also bettered
the legal team because people aren’t afraid to bring issues
directly to us,” she explains.
Another factor that makes Miller’s legal team and the
entire organization better is University Hospital’s prioritization of diversity. “We serve an incredibly diverse

83

IMPACT

Congratulations to
our friend and colleague
Janet Miller

on this well-deserved
recognition!

AHL APR.MAY.JUN 2017

Benesch applauds Janet for her
visionary leadership and unwavering
dedication to University Hospitals.

84

www.beneschlaw.com

and after they work with us, we have the
ability to follow them in their careers,”
she explains. To capitalize on this homegrown pool of potential future hires, all
interns complete an intensive, two-day
in-house training course (for which they
often receive course credit) to prepare
them for both their internship and their
career. “We’re building our own talent
and setting our interns up to get great jobs
when they leave us,” she says.
Miller is committed to helping others
find creative solutions to complex problems and for investing in others—from
her interns to her team to business
partners, patients, and the community.
Her goal is to set up her talented staff
with the ability to reach their hopes and
dreams, and if they are recruited away
from University Hospitals, it’s Miller’s
hope that they duplicate and advance
those values elsewhere. She is a champion of values like innovation, excellence, compassion, and teamwork, and
believes that diversity brings unity, creativity, and a better ability to solve new
issues. “If I do my best to fight for values
like these in my corner of the world,
maybe others will, too,” she says. “And
maybe soon, every corner of the world
will be better together.”
Fortunately, Miller has found the perfect
corner of the world to start, and thanks to
her colleagues at University Hospitals, it’s
getting bigger all the time. AHL

Expertise is a factor, he says, because in a highly regulated, specialized industry such as healthcare, the ability
to keep up is always critical. Cost is another, since overcharging is prevalent among several law firms—especially larger ones, in Burres’s experience—and he doesn’t
want Rotech to fall victim. “We seek explanations [for
overages] and keep them in our arsenal,” he says. “We
may let them complete the project assigned, but we won’t
give them the rest of our business if we notice abusive
time-keeping practices.”
Case in point: Burres recalls a law firm that not only
rewrote a legal brief twice—billing fifty hours for each
writing—but also billed for having its paralegal check
over the same document. “If you’re paying for the lawyer
to write it, you’re paying for the research, fact-checking
. . . you’re paying for it all,” he notes. “I’m not paying
someone to check someone else’s work. That’s what we
felt was abusive. And we eventually fired them.”
Integrity is the third key, and as a somewhat more
straightforward concept than trust, it has to do with
respecting the way a business operates. “Trust is harder
to weed out than integrity,” Burres explains. “Trust you
can mask. Integrity comes out in the bill.”
Of course, solid answers to questions—that is, “an
answer we need, and one that’s not drawn out”—are
a good indicator of a firm with which Burres enjoys
working. Reciprocated appreciation and respect go a
long way, as well. “We always like firms that want our
business,” he says. “You can’t teach hungry. It’s an innate
quality that lawyers either have, or they don’t.”
While he ideally has all three keys at all times, Burres
acknowledges that it’s easier said than done in certain
situations. Medicare is one example, while litigation for
car accidents and workers’ compensation is another.
“When a Medicare expert is needed, it comes at a cost,”

STEVE BURRES
General Counsel
Rotech
Healthcare Inc.

AHLMAGAZINE.COM

Long before he joined forces with
Rotech Healthcare Inc. in January
2014, Steve Burres had a fondness for the
medical industry. He previously worked
with large hospital systems while in
private legal practice, and he also knew from past experience that he had a knack for efficiency and a solid sense
of how long certain practices and procedures take.
These experiences helped Burres develop a keen eye
for cost discrepancies, one that would eventually benefit
all of Rotech—once Burres moved into more of a leadership position there, at least. So he paid close attention,
and he waited.
“When I did get in a position where I could question
the bills, I used my past experience as a guide and finally
said, ‘Enough is enough; this abuse has been going on too
long,’” he says.
Rotech is a leading industry provider of CPAP
machines, home oxygen therapy, and other medical
equipment and services. As such, Burres has a wide range
of responsibilities: in addition to overseeing the legal
department, he is the secretary for the entire company
and handles matters dealing with the board of directors.
On top of all this, he also manages all active claims—
litigation and workers’ compensation—leads equipment
repossession projects, negotiates with insurers, drafts
contracts, and negotiates leases for all of Rotech’s 400
locations nationwide.
While other companies may have a team of lawyers,
Burres is the only lawyer at Rotech, making his handling
of the legal department all the more impressive. He cites
hard work and well-honed time management skills, but
Burres also relies on three factors to successfully navigate murky waters and come away with the best partnerships: expertise, cost, and integrity.

85

IMPACT

Young Conaway
joins American
Healthcare Leader
in congratulating
Rotech Healthcare’s

he explains. “There’s not much you can do
about that. If you don’t want to pay the high
billable rates, you will likely not get a lawyer
with the necessary expertise you need to
handle the issue.”
These are the instances, he says, when
he must be sure to manage time as well as
money. “If it’s a small issue, I tell the law
firms [in advance] that I don’t want a certain
action to go over five hours,” Burres says.
“And if it has to go over, they need to call me
and tell me why. In all honesty, when they
know you’re looking at the bill, they work
more efficiently.”
Across-the-board efficiency has certainly
worked in Burres’s favor thus far, considering Rotech’s legal department has come
in at about 20 percent under budget annually since he’s taken leadership. And that’s
with his in-house staff comprised of only
three people: himself, one paralegal, and a
risk manager. With that kind of success, it’s
easy to see why Burres feels no need to hire
additional staff. That is, unless Rotech itself
were to upgrade in size—an idea he finds
quite appealing.
“I know my peers have departments with
around eleven or twelve lawyers, and I’m just
one,” he says. “But if we continue to grow
and expand in the marketplace, I can see an
argument being made to successfully grow
my department.”
For the time being, though, Burres is
pleased with what he and his team are able
to accomplish on a daily basis. “I think
everybody’s always looking to trim costs,
and when it happens, I think it shows your
added value,” he says. “There has to be a
mutual respect for one another to get things
done, and I think we have that in the Rotech
legal department.” AHL

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sustainability, but also helps eliminate variation and
improve the patient experience and outcome.”
An additional initiative in this realm is in payment
reform, in accordance with the position that the underlining fee-for-service structure is not sustainable in
the long run. “It doesn’t align incentives—it rewards
quantity versus quality—so we’ve been very active over
the course of the last five to six years in moving to more
value-based payments,” Johnson says. “We’re committed
to that journey and think it’s the right thing to do.”
UnityPoint’s fee-for-value movement started small,
with one of its smaller regions, Fort Dodge, becoming
active in the Pioneer Program through Medicare. Several
other regions later joined managed security service
providers (MSSPs), learning how to manage populations. Then, it jumped into some commercial contracts
with larger payers in the region. Today, UnityPoint has
advanced to participating in NextGen solutions.
“We really thought we had to get into these to understand how they worked. If we just waited until we felt
we had all the capabilities developed, we would have
probably never done it,” Johnson says. “In addition to the
payment transformation, we’ve also done more on the
clinical side of the house, working on how we can better
provide care for patients.”
It’s what UnityPoint refers to as “care coordination.”
“Moving from a primary care office to a specialist
office to potentially needing hospitalization, we are really
trying to figure out how to better do those transitions in
care,” he adds. “We also realized not all of our patients
need the same thing, and we are launching several different programmatic ways to meet the needs of patients

AHLMAGAZINE.COM

“Foundational competency” is a phrase
to live by for Mark Johnson. “It’s something that we know we have to do, and
have to do it well,” Johnson, senior VP and
CFO for UnityPoint Health, says. “Sustainability is one of those core competencies. Employee
engagement is another; physician engagement another,
along with patient experience. We know it’s all important
to be successful.”
Sustainability overlaps with all facets of the operation at UnityPoint Health, an integrated health system
providing care throughout Iowa, western Illinois, and
southern Wisconsin through more than 280 physician
clinics, thirty-three hospitals in metropolitan and rural
communities, and home-care services throughout its
nine regions. “It resonates in everything we do,” Johnson
says. “We really worked hard to marry our system-wide
planning process with our budgeting process, so as we
have new initiatives, having more rigor around our business planning and getting it in the budget has become an
important step for us.”
All sustainability initiatives at UnityPoint entail biannual reports to the board of directors on their progress,
and Johnson works with different regions, clinics, and
hospitals to make sure they’re financially on track.
When it comes to UnityPoint’s long-term financial
sustainability, Johnson focuses on several points. “One
is we feel we need healthy and cost-effective operations,
and we have had a formal sustainability program since
2011,” he says. “Really, our focus is on how we eliminate
waste, how we become more efficient, and how we implement best performance that not only drives financial

87

IMPACT

Thank you
for your
continued
support
Mark Johnson

“Really, our focus is on how
we eliminate waste, how we
become more efficient, and
how we implement best
performance.”

AHL APR.MAY.JUN 2017

that meet a broad spectrum, so we’re providing the right
care, at the right time.” Take, for example, a healthy twenty-five-year-old who wants quick, convenient options
such as virtual care, telehealth, and the ability to communicate with a doctor electronically—or a senior patient
who needs help managing multiple chronic conditions.
Part of Johnson’s responsibility is to help drive what
the best practices and procedures are for the company,
and then to populate them across its entire system. “If
you look at our history, we came together from independent, free-standing facilities, and when we first started,
our mantra was—and we still feel—that healthcare is
local and left a lot of autonomy to the regions,” he says.
“As we matured as a system, there are certain things that
are best practices, and although there may be a local
nuance, we strive to do them in a consistent way.”
To that end, UnityPoint recently put together a Clinical Leadership Group, where representatives from all
regions and parts of the care continuum meet to determine best practices and performers, validate that their
conclusions are evidence-based, and then apply them to
the appropriate groups. “We also started having quarterly meetings between our regional leadership and
system leadership, and what we do is look at high-level
KPIs, or key performance indicators. For those that are
successful, we ask them what they’re doing and point
them out to their peers,” he says.
Though he majored in finance in college, Johnson
wasn’t interested in pursuing a job in the banking industry and looked for a way to apply his skill to an industry
that helps people. He considers today to be one of the
healthcare industry’s most exciting eras. “Healthcare
is an industry where you have constant technology
changes, which is always exciting and can be an enabler
to the strategies we are working on,” he says. “The transformational nature of the industry is what sets it apart
from other industries right now.” AHL

U.S. Bank is honored to be a trusted choice for the health care industry and
helps organizations like UnityPoint Health reach their business goals by offering competitive products and services accompanied by sound financial
strategies backed by our proven capability and stability. We are proud to call
UnityPoint Health our client and friend.

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U.S. Bank is proud to support UnityPoint Health.

Welcome to the
Future of Pharmacy
Gary Johnson has helped revolutionize University of Kentucky HealthCare’s
operations and patient care through innovative ambulatory pharmacy services
By Jeff Silver

Gary Johnson stepped into his position at chief pharmacy officer with a
mandate to focus on inpatient care at
University of Kentucky HealthCare
(UKH). But he also brought a vision for
developing a much broader approach to how ambulatory
pharmacy services could make significant contributions
to the well-being of the 900-bed hospital’s finances and
patients. An agreement was reached that as long as he
met the inpatient objectives, he was free to develop an
ambulatory pharmacy model. Since then, ambulatory
pharmacy services have become the single largest contributor to UKH’s bottom line.

AHL APR.MAY.JUN 2017

How large of an increase have you made in UKH’s
pharmacy services in the last five years?

90

Gary Johnson: When I arrived, there were only two
retail pharmacies. Now, we have six retail pharmacies
providing prescriptions for many patient types, including discharge, same-day surgery, emergency department,
clinic, contract pharmacy, specialty, and employee prescriptions. These combined activities have resulted in an
annual ambulatory pharmacy net income growing from
$12 million to $86 million.

Was there internal resistance to your plans?
Johnson: Health systems typically don’t think of prescriptions as a source of value, but they are why big retail
chains put stores around hospitals. UKH actually wanted
to close one of its two original retail pharmacies to eliminate the operational costs. We had to educate stakeholders on the benefits of an aggressive ambulatory pharmacy
program, which included expanding the federal 340B
program that facilitates large medication discounts for
hospitals with indigent patient populations that exceed
11.5 percent—as well as our work with program vendor
partners Verity and ScriptPro. Our rate for Medicaid and
uninsured patients is around 30 percent, so that presented tremendous possibilities. We had to help senior
leadership understand the opportunities this kind of
program could provide.
Aside from the financial advantages, describe some of
the other benefits you’ve been able to provide.
Johnson: Rather than lose prescription processing to
commercial chains, we’ve tried to drape an iron curtain
around the entire health system. That allows us to integrate the full continuum of care. We share information

IMPACT

with physicians about whether patients are complying with their medication regimens. We have merged
inpatient and ambulatory care so that when a patient is
admitted we reconcile their current medications with
what they need while inpatient. Then, when they’re discharged, we explain the new prescriptions, how to take
them, which of the old ones to discontinue, and offer to
fill the new ones. We even deliver their discharge prescriptions directly to their rooms through a concierge
service we call Meds-to-Beds that is in conjunction with
ScriptPro. When it first started, we were providing discharge prescriptions for about 15 percent of patients.
Now it’s up to 60 percent, and we’ve seen a corresponding
15 percent decrease in the number of patients coming
back through the emergency department. We’re also able
to provide specialty medications within twenty-four
hours instead of patients having to wait up to two weeks
to get them through the mail.
Can you explain more about the specialty pharmacy
services?
Johnson: New biologic drugs are being derived from
human plasma and other organic proteins that are highly
effective at curing, not just treating, conditions like
hepatitis C. Within three months, these new drugs can
remove the hepatitis C virus from the body, but it’s very
expensive—up to $100,000. We work with our laboratory
genomics department to determine the patient profile
and the appropriate duration of treatment. To comply
with manufacturers’ protocols and insurers’ requirements for dispensing, we also established a call center
that contacts patients to monitor compliance and is
available to answer their questions around the clock. All
of these services and capabilities have also been developed with ScriptPro and have succeeded in creating a
specialty pharmacy program that contributes 40 percent
of UKH’s monthly income from operations—and that’s
from a total of 2,000 prescriptions compared to 35,000
that make up the remaining 60 percent.

Johnson: We introduced a lot of automation. We
use five high-density storage carousels provided by
Talyst that hold $5 million worth of medications. Each

“Health systems typically don’t
think of prescriptions as a
source of value, but they are
why big retail chains put stores
around hospitals.”
AHLMAGAZINE.COM

As you’ve expanded pharmacy services so extensively,
how have you also managed to improve efficiency?

GARY JOHNSON
Chief Pharmacy
Officer
University
of Kentucky
HealthCare

91

IMPACT

carousel responds to prescriptions that originate from patients’ EMRs and delivers them
to the pharmacist. They’ve reduced medication errors by 76 percent. We’ve integrated
the software controlling carousel delivery
with the hospital’s electronic records so clinicians can all access real-time information
regarding the status of medications being
delivered to the floor. The inventory automation also tracks everything that we dispense
on a daily basis and automatically suggests
orders to maintain a five-day par level for
every drug. That has helped reduce overall
inventory by 35 percent.
In addition, we use a robotic arm to
prepare IV medications. It’s sealed, so
contamination is nonexistent and we can
mass-produce drugs with long expiration
dates, which isn’t possible when preparation is done manually. With lots of drug
shortages, we can compound drugs—such
as nicardipine—that manufacturers stop
making and then often reintroduce with
tremendous price increases.
What are your future plans at UKH?
Johnson: I want to continue expanding
the ambulatory pharmacy infrastructure,
so we can service an even broader array of
patients. AHL

AHL APR.MAY.JUN 2017

UK leads the way in end-to-end systems integration.
ScriptPro salutes Gary Johnson and University of Kentucky
for creative, intelligent, inspiring leadership. UK’s pharmacy
program is a model for ambulatory patient care and health
system financial success. Together, University of Kentucky
and ScriptPro are advancing healthcare.

92

Dr. Gary Johnson’s idea to outsource day-to-day management of his hospitals 340B program to the experts at Verity
Solutions has been an unqualified success with an increase
in 340B savings. Internal compliance and auditing efforts
are also much stronger. ROI exceeded expectations without
counting labor savings and redeployed labor.

Talyst is proud to partner
with UK HealthCare in
their mission to deliver

unparalleled
pharmacy
services.

IMPACT

If She Builds It,
They Will Come
How Megan McKinnon is thinking beyond salary to create the ideal workplace at Piedmont Healthcare
By Chris Gigley

The survey is part of a parallel initiative McKinnon
has led to upgrade technology and analytics processes
in the human resources department. This included
the creation of an HR dashboard in 2015 that gave the
department streamlined access to a variety of data,
from flu shot compliance to average response times at
call centers. McKinnon also rolled out a cloud-based
system that links a number of different processes that
had previously been fragmented.
“Now we have a one-stop shop for technology where
we can track succession planning, do talent reviews and
surveys, and implement merit increases,” she explains.
“Before, it was all in different systems with different
logins. Transparency is vastly improved because employees have access to information they didn’t have before.”
Meanwhile, McKinnon and her team have implemented the Promise 360 employee recognition program
in 2015. According to an employee survey, it’s been a
success. “The results showed that employees being recognized for the work they do was our top strength,” she
says. Promise 360 allows patients, peers, and managers
to nominate employees who exemplify one or more of
Piedmont Health’s core values. Each of its six hospitals
award one employee monthly, but the company also goes
to the next level, honoring one exceptional employee
annually at a special dinner. “That whole program will
be a prominent part of our employee value proposition,”
McKinnon says.
Outstanding leadership will also be a key component,
and McKinnon understands that she must serve as a

Megan McKinnon is on a mission
to make Piedmont Healthcare a top
workplace destination by 2026. And
while she has focused on compensation
for much of her career, she understands
it’s not always about money. “It can be, and we pay competitively,” the executive director of compensation and
rewards says. “But it’s driven me to figure out other ways
to build a connection with employees so they don’t leave
for an extra few dollars.”
McKinnon is already well on her way to hitting several
key milestones toward her goal, including a turnover rate
of less than 10 percent and placing the company in the
75th percentile in employee engagement.
She and her team recently launched an awards optimization tool born out of results from a company-wide
survey that gave Piedmont Health employees a say in
the process. McKinnon explains that survey questions
weren’t just designed to show whether employees preferred, for instance, lower health insurance premiums
over a gym membership, or richer retirement plans
rather than larger bonuses. It also touched on work-life
balance issues, such as the importance of flexible hours.
“The bottom line is to find out what we can do to be
a top workplace for employees at every distinct part
of their career journey,” McKinnon says. Although she
joined Piedmont Healthcare in January 2012, McKinnon thinks there is always more to learn as the company
grows and changes. “We want to know what makes
employees feel valued so we can deliver that to them.”

93

IMPACT

94

good example for other managers. Not only is she quick
to recognize her staffers, but she also ensures they know
nearly everything she does. “My whole leadership goal
is to create an environment where, if I were to walk out
the door today, there wouldn’t be any impact because the
team is so strong that they can pick up and go with it,”
she says.
McKinnon also gets her employees face time with
senior leaders at the company whenever possible. She
invites them to meetings they otherwise would never be
part of, and if she can match an employee’s passion with
a project in another department, she will recommend
him or her for it.
McKinnon understands the value of a strong internal
network, having built a strong one for herself over the
years. “You figure out who can help you achieve different
components of different projects, and if they need something from me, I try to deliver,” she says. “I think having
integrity and delivering on what you say you will deliver
on is key to building that strong internal network.”
So is backing everything with data. “I tend to be able to
position information to them in a way that makes sense,”
she says. “It’s just listening and learning what their concerns are and how you can best address those. I learn
something every day about how I can contribute better.”
McKinnon considers herself a hands-on manager. She
does all the work her team does so she understands their
challenges. At the end of the day, they all feel fully supported by her. “If they make a mistake, they know I have
their backs,” she says. “I always assume good intent. If
you treat employees well in terms of the flexibility you
give them, they’ll really work hard for you and won’t want
to disappoint you.”
Piedmont Healthcare has given McKinnon the same
kind of flexibility in her career. The least she could do,
she says, is make the company one of the best workplaces
in the country: “I really have a passion for the employee
experience because I love Piedmont and I want every
employee to feel connected like I do.” AHL

“The bottom line is to find out what we can do to be a top
workplace for employees at every distinct part of their
career journey. We want to know what makes them feel
valued so we can deliver that to them.”

Congratulations to
Megan Mckinnon
Executive Director of Compensation and
Rewards at Piedmont Healthcare
Megan, we salute you for leading Piedmont Healthcare to realize
its vision of becoming a top workplace in the health care industry.
We look forward to partnering with you and Piedmont Healthcare
for years to come.
Together, we unlock potential.

willistowerswatson.com

IMPACT

Acclimation by Immersion
General counsel Jerard Jensen sheds light
on shifting from CEO to in-house counsel,
his role today with Marshfield Clinic

AHL APR.MAY.JUN 2017

By David Baez

96

Even when he was in private practice
and serving as outside counsel for the
medical practice management firm
MGMA, Jerard Jensen, general counsel
for Marshfield Clinic, felt at home in the
C-suite—and the board felt good about him being there
as well. So much so, in fact, that when MGMA’s CEO took
another position, the company asked a surprised Jensen
if he would be interested in serving as interim CEO while
they conducted the search for a permanent replacement.
“I had a close role with the board and senior management, so I was already functioning in a C-suite manner,
but I wasn’t expecting to be offered the position,” Jensen
says. “I recall sitting in an airport when the question
was put to me, and the next thing I knew, I was talking
about how it was going to work. A lot of things happened
very quickly.”
Jensen was interim CEO at MGMA from the fall of
2014 until the spring of 2015, when the company found
a permanent CEO. He stepped back and resumed his
former role with the company briefly, but at that point he
had already decided he was going to take a job as general
counsel with Marshfield. His experience in the C-suite
heavily influenced the decision to go in-house.
“I really enjoyed the CEO role,” he says. “I think that’s
a big part of why I moved into an inside general counsel
position. You are an inside C-suite executive and as much
a businessperson as a lawyer. Your legal skills are used in
that context from a business perspective, rather than the
pure lawyering skills you use when you’re representing a

client. I like looking at business and organization results
as opposed to simply legal results.”
Taking the helm of legal for the vast delivery system,
which has been prominent in Wisconsin since the early
twentieth century, was a head-spinning experience at
the outset, something Jensen characterizes as “immersion acclimation.” He took the seat of the interim general
counsel and promptly got to work in a culture he knew
little about.
“The organization has an iconic reputation, and I knew
about that, but I didn’t know much about how things
worked internally,” he says. “Those first weeks were very
long days with a lot of meetings. I had to meet my own
staff for starters, and then I had to spread out and get to
know dozens of senior leaders. I had to immerse myself in
things structurally and organizationally at first and then
begin to understand the culture. Learning on the run is
challenging, but it was also exhilarating.”
In spite of his C-level position, Jensen recognized that
he was also the new kid in town and made sure not to
interfere with preexisting dynamics in the organization,
which had been working quite well; there was no need
to fix what wasn’t broken. His staff is small, with only
six direct reports: one is devoted to professional liability
issues, a second handles physician/clinical issues and
regulations, a third deals with facilities contracts, and a
fourth works with IT and intellectual property matters.
As the hospital begins the push to expand its scope by
acquiring St. Joseph’s hospital and bringing acute care
to its Eau Claire facility, the plan is to grow the team. In

Orrick is a San Francisco, California based firm with offices
in 25 markets across the United States and worldwide.

orrick.com

AHLMAGAZINE.COM

the meantime, they use outside counsel
for advice on antitrust law, employment
issues, and a host of other areas that fall
outside the scope of the team’s expertise.
“As general counsel, I have the obligation to decide how the legal discipline is
applied to secure our business objectives,
but I can’t even begin to think about doing
all that’s necessary to accomplish those
ends,” he says. “I need to rely on other
inside counsel here, as well as outside
counsel. I expect my outside counsels to
have a clear idea of what my organizational strategies and needs are. I don’t
want detached opinions; I want somebody
to understand my business and to facilitate a business end for me using the legal
skill set.”
Jensen says that the major challenges
he sees facing Marshfield—and any
healthcare organization for that matter—
are regulatory issues and industry consolidation. He believes that changes in
internal business processes due to regulatory changes will be more difficult
than the changes with how organizations
interact with government. In addition to
handling all that compliance, legal will be
at the forefront of the vertical integration
of care delivery, getting there from the old
system of fragmentation. As he deals with
these external forces, Jensen says he isn’t
done learning about the organization he
joined a year-and-a-half ago.
“For the first week or so, my head was
spinning, but then things settled down
and I formed a perspective,” he says. “Over
the next month or so, I felt pretty much at
home. But I was always open to learning
more, and I still am today. I know enough
now to function effectively in my role, but
I don’t know, with an organization like
this, that I’ll ever know everything.”
“As long as you continue to remain
willing to learn more, you’re in a position where you can continue to improve
your performance.” AHL

Many professions are vulnerable to
hits when the economy plunges, yet
unemployment among physicians generally stands at less than 1 percent—
irrespective of economic conditions. As
a result, this makes recruitment in the industry distinct
from other professions, according to Michael Lynch,
HealthCare Partners’ senior vice president of clinician
recruitment and retention.
“Unlike with lawyers or IT, where there is an ebb and
flow of demand for those services, in healthcare, the
demand hasn’t gone down,” Lynch explains. “It shifts,
but it stays in the general sphere. The way people access
their healthcare may be different, but the demand is
always there.”
Physicians who are looking for a change also tend to be
passive job seekers; if they openly pursue a new position,
it could have repercussions in their current role. This
presents a major challenge to HealthCare Partners in its
recent recruitment initiative, but Lynch is at the helm of
finding solutions.
As the industry began to shift its focus from volume
to value with new healthcare laws in 2012, HealthCare
Partners’ executives concentrated on not only finding
high-quality physicians, but also ones whose approach
harmonized with the company. The culture at HealthCare Partners is singular, which Lynch says is “one of
the most unique I’ve seen in healthcare.”
The company has been studied by leading business
schools examining how culture effects dedication
among employees. Indeed, Healthcare Partners’ language reflects its emphasis on community: the CEO is
referred to as the company’s “mayor,” and employees are
“teammates of the village.” The company’s core pillars

are also expressed in its trilogy of care: caring for our
patients, each other, and the world.
HealthCare Partners is not shy about its ambitions
in this space, having declared a mission of becoming
what Lynch calls “the greatest healthcare community
the world has ever seen.” To reach this lofty place, it is
essential to increase patient access to care and have just
the right physicians in place.
In searching for physicians, Lynch and HealthCare
Partners look at a doctor’s philosophy of practice, as well
as the quality of their work. He notes that most physicians chose this line of work not only to treat those who
are ill, but also to keep them healthy overall, which is in
line with HealthCare Partners’ focus. In their recruitment campaign, HealthCare Partners shows them that
this model of medicine—as opposed to the volume-based
assembly line model—exists, and that doctors don’t have
to be in a small physician group with all its attendant difficulties to practice it.
But how does one get this information to physicians
when many are veiled in their present jobs? To get around
this obstacle, HealthCare Partners has begun a grassroots campaign to get face-to-face with as many physicians as possible. For the past two years, the company
has been active with the American College of Physicians
and other professional associations, putting HealthCare
representatives in the company of more doctors. Every
year, it hosts the opening reception at the AAFP’s annual
Family Medicine Experience conference. The company
also goes to medical schools and speaks of its trilogy
of care, planting the seed with students on the cusp of
becoming physicians.
“Things like e-mails and direct postcards won’t
cut it,” Lynch explains. “We try to be face-to-face and

“The way people access their
healthcare may be different, but
the demand is always there.”
Experience
is always in demand.
And we have the supply.
For more than 20 years, we’ve
helped large healthcare networks
gain access to better doctors,
ensuring a higher quality of care
and increased patient satisfaction.

CONTACT
Cindy Slagle
at 954.837.2369.

AHL APR.MAY.JUN 2017

weatherbyhealthcare.com

100

actually use the old-school method of calling physicians
in a certain practice area and talking to them, asking for
five minutes of their time, and telling them who we are
and what we’re about. We tell them, ‘If you practice with
us, you can do it the way you always wanted to.’”
Once they get face-to-face with physicians, or prospective physicians, they talk about focusing on patient
satisfaction along with balancing cost for procedures.
HealthCare Partners gives patients more time with
physicians than the ten-minute visit model allows, so
the doctor can get to know all of the patients’ needs.
The company strives for better coordination across the
spectrum of the patients’ care and eliminates redundant
procedures and testing. When patients are in the hospital for a procedure, all the information is immediately
transferred to the primary care provider.
HealthCare Partners hopes to find eager ears when
passing along this philosophy at conferences and medical
schools. And, Lynch says, it’s been working. “We’ve been
able to increase the quality of our physicians from a clinical standpoint, as well as the alignment of mission values
and philosophy,” he explains. “It’s also allowed us to take
top-grade physicians within the organization and free
them up to take up leadership positions. In 2016, we’ve
already met our hiring goal before going into the fourth
quarter for most markets. Over the past twelve to eighteen months, it’s been a godsend.”
As the recruitment efforts continue and more physicians align with HealthCare Partners’ mission, the company’s culture is amplified and the lofty goal of being the
greatest healthcare community becomes more attainable. “We don’t think being the most profitable or the
biggest makes us the greatest,” he says. “It’s the trilogy
of care and our philosophy of patient care, and my drive
is to push that culture to our patients and physicians and
have everyone feel that.” AHL
According to a 2013 benchmarking survey from Association of Staff Physician Recruiters* (ASPR), it takes between 131 and 184 days for a hospital’s
in-house recruitment team to fill an open position, depending on the specialty. In many cases, this long hiring process results in significant revenue
loss for the facility. As a result, locum tenens physicians are often called
upon to work temporary assignments in these facilities. Not only does it
take less time to get a locum into a position (usually about sixty days, and
sometimes sooner), but using locum tenens ensures that patients can still
be seen, hospitals can earn revenue, and that the existing staff doesn’t burn
out. With access to more physicians through Weatherby Healthcare’s extensive network of quality providers, facilities can help maintain their ability
to provide care while reducing the amount of time it takes to fill a position.

as CareFirst’s Patient-Centered Medical Home (PCMH)
program, among other programs designed to better
integrate patient data, to provide better resources for
primary care, and to improve and streamline care for the
sickest members. The CareFirst legal team has played a
vital role in ensuring that such programs are developed
and implemented in compliance with a broad array of
federal and state laws, as well as regulations.
Sergent and his team must also help guide each initiative through issues such as conflicting state and federal
privacy laws, insurance laws, federal tax laws, laws governing the provision of medical care, marketing laws, and
more. “For all of those programs that can have a direct
impact on member care, it’s important that my team
is able to get in at the ground level and help design the
program in a way that it works for the business within
the existing regulatory framework,” Sergent says.
When he’s not handling complex projects, Sergent’s
days are spent handling the challenges that come with
being a legal professional in the medical industry. One
such challenge is the sheer volume of new laws his team
encounters. The Affordable Care Act and its regulations
stand out, but other examples include changing privacy
regulations, state insurance laws, and antikickback and
antifraud requirements.
Sergent and his team must also rapidly digest new and
changing laws as they emerge in order to enable CareFirst to adjust its operations as needed. “The key is that
we have to be proactive as a department. We can’t wait
for someone to bring problems to us,” he says. “We have
to understand deeply what the business needs are, where
it’s going, and what it wants to do so we can identify the
legal problems before they become business problems.”
Sergent is in an interesting position, as he doesn’t just

AHLMAGAZINE.COM

At any given moment, Randy Sergent
has a lot on his plate working for
CareFirst BlueCross BlueShield, but it’s
a scenario that he’s been preparing for his
entire career.
Sergent, who is the vice president, deputy general
counsel, and assistant secretary for CareFirst, manages
the Baltimore legal office, which is roughly half of the
company’s legal department. He leads his team of attorneys in providing advice on the corporate and regulatory
issues for the company, while also managing a team
that prepares and obtains approval of member benefit
contracts, policy forms, and similar documents. Before
taking on this role, though, it was his career path itself
that made him more than ready to take on this type of
leadership position.
Prior to joining CareFirst, Sergent was a partner with
Venable LLP, where he was involved in insurance regulatory matters and litigation. He also served as deputy
counsel to the Maryland Insurance Commissioner and
as an assistant attorney general within the civil litigation
division of the office of the Maryland Attorney General.
“In a heavily regulated industry like health insurance,
it’s important to have a broad perspective,” Sergent
explains. “For what we do day to day in-house, we quickly
need to recognize which are the important issues and
which are not, and how the business project is going to be
shaped by the regulatory environment. It often requires a
lot of nuance and understanding, and a broad background
and deep business understanding really is necessary to
bring your full abilities to bear on what you’re doing.”
Sergent is constantly working on numerous projects,
but one of his team’s most important ongoing initiatives
is the provision of advice-to-patient care initiatives, such

101

IMPACT

Wiley Rein LLP
congratulates

Randy Sergent
for his well-deserved
recognition and
profile in
American
Healthcare
Leader

C

M

Y

CM

MY

CY

CMY

K

AHL APR.MAY.JUN 2017

We are honored
to continue
our relationship
with Randy and
CareFirst BlueCross
BlueShield

102

wileyrein.com

“If there was one thing I would
tell a young lawyer on how to
become successful in this field,
it would be to learn not just
the law, but learn your client’s
business thoroughly.”
manage other lawyers, but he also gets into the mix when
needed. He will often take a lead role, particularly on high
profile, sensitive projects. He also has to find time for
the third leg of his managerial role: overseeing and supporting the contracting team that prepares and obtains
approval of policy forms, contracts with employers, and
similar documents.
While it’s not strictly a legal function, it is an important role for the company that is highly deadline-oriented
and involves making sure approvals are obtained and
forms are loaded into the company’s system for the entire
spectrum of the company’s products.
“I think you balance [different roles] by paying close
attention to all of them and giving them the time that
they need,” he says. “I’m not sure I have a magic formula
to it, but the variety keeps you on your toes. It certainly
makes me a better lawyer to have a business unit with
non-legal concerns as part of my responsibility. The real
key, though, is to have an excellent team on whom you can
rely. Our legal and contracting teams are highly skilled
and motivated, and often, I am supporting them as much
as or more than directing them.”
The general counsel isn’t shy about admitting his job
is challenging, but he also believes it’s a good time to be
an in-house counsel. One main reason is because he gets
to be part of a team pursuing a company mission rather
than just serving as an outside consultant and because
in-house legal work is becoming increasingly sophisticated. As in-house counsel, he gets an opportunity to
learn about a variety of different subjects, and he believes
it’s important to know how the business operates nearly
as well as his clients.
“For example, if I need to advise finance on something,
I’m going to also need to understand the non-legal constraints that finance is functioning under to give legal
advice that makes sense and is workable,” he says. “If
there was one thing I would tell a young lawyer on how
to become successful in this field, it would be to learn not
just the law, but learn your client’s business thoroughly.
Your solutions will make sense only when you understand the problems that your clients face.” AHL

IMPACT

No Small Wonder
Milford Regional Medical Center may have a smaller IT division than many other organizations,
but that hasn’t stopped Nicole Heim and her team from producing big results
By Joe Dyton

NICOLE HEIM
CIO, VP
Milford Regional
Medical Center

Heim admits the role is a tough tightrope to walk
between satisfying users’ requests to make information
systems more usable and keeping their information
secure. “Sometimes those requests introduce additional
security risks,” Heim explains. “I’m weighing security and
usability, and it goes either way depending on different
scenarios. Often, the security requirements we need to
put into place add a layer of frustration to users, so I think
it’s really important to have communication so staff are
aware why we have to put these measures in place.”
Two security options Milford Regional may add to
its portfolio are secure texting and data loss protection
(DLP). Secure texting was identified as a need last year,
especially for physician-nurse communications. Currently, Milford Regional is in the middle of its investigation for a secure texting solution and hopes to have one
during fiscal year 2017. DLP is a different story. Heim
admits her team has been looking at it for some time,
but the high costs are an issue. For the time being, the
IT division is looking at a proof of concept to see how
big the risk is.
“We have policies and procedures in place of course
to protect our data, but DLP just makes it easier for us
so we can set in policies and enforce it automatically
versus just educating the staff on what they shouldn’t
be doing,” she says.

AHLMAGAZINE.COM

At Milford Regional Medical Center,
phrases such as “not enough resources”
or “not enough people” don’t serve as
excuses for not getting the job done.
Instead, they are used as fuel to push even
harder to achieve success.
The nonprofit, acute care hospital based in Milford,
Massachusetts, houses 145 beds and serves a region of
more than twenty towns. It resides under the Milford
Regional Health System umbrella, along with TriCounty Medical Associates and the Milford Regional
Healthcare Foundation.
The IT division, led by chief information officer and
vice president Nicole Heim, comprises just fifty people,
but provides support to all physicians, nurses, and other
employees of the medical center. Heim’s responsibilities include overseeing all applications, interoperability, informatics, networking, system administration,
technical specialists, help desk, switchboard operation,
telecommunications, and clinical engineering.
Since Milford Regional is a small community hospital,
many senior leaders have to wear multiple hats. One of
Heim’s hats is Health Insurance Portability and Accountability Act security officer, a key position, as protecting
patients’ medical files is at the top of the security team’s
priority list.

103

AHL APR.MAY.JUN 2017

IMPACT

104

Along with keeping its patients’ information secure,
Milford Regional has also accomplished a lot over
the past few years, despite being a lean operation,
personnel-wise. In 2011, the first year of the program, it
achieved Meaningful Use Stage 1 and reached Stage 2
just three years later. This past year, Milford Regional
was recognized by the Healthcare Information and Management Systems Society as a Stage 6 hospital and is currently looking at the requirements to hit Stage 7, which
will include going completely paperless.
“It was a rush to implement a fair number of projects
to achieve those meaningful use milestones, and we
received more than $2 million in incentive payments
from the government,” Heim says. “We could use that
money to invest back in technology and the hospital
in general.”
As a whole, Milford Regional also has its sights set on
reducing patient readmissions. It received a grant in 2013
from MeHi and used the funds to pilot sending post-discharge continuity of care documents to a visiting nurse
association and a skilled nurses facility, a program which
proved successful.
Milford also received two more grants through
the Health Policy Commission to focus on reducing
readmissions, which it used to reach out to other organizations to encourage them to connect to the Massachusetts Health Information Highway (also known as the
HIway). Unfortunately, a lack of personnel or resources
prevented other organizations from moving forward with
the connection. Milford Regional was able to offer some
of the grant funding to help these other organizations pay
the initial cost to connect to the HIway, but even with
the added support, it turned out that they weren’t able
to connect to the project long-term.
“It was rather frustrating for our staff because it wasn’t
through any lack of effort on our part,” she says. “Those
facilities are just not in a position yet to connect electronically. They must still rely on paper.”
Milford Regional also looked at technology to assist
case managers as a way to help reduce readmissions.
However, it was determined the most impactful intervention in the chart grant initiative was its people.
Milford Regional has a staff who works with patients
while they’re at the hospital and then postcharge to make

“We in IT don’t obviously provide
direct patient care, but we
definitely have a huge part in
assisting the clinicians that do.”
sure they have their medications and appointments,
and sometimes help with transportation to and from
those appointments.
“We definitely look for technology to help us, but in the
end, I think the most impactful intervention again is the
people resources we dedicated to this project,” Heim says.
When she’s not running the IT division and helping
to keep patients’ information safe, Heim gives national
talks to fellow industry professionals. One of the messages she hopes to get across is the need to leverage technology to assist hospital business operations and help the
clinical staff improve their workflow so they can focus on
providing high-quality care.
“We in IT don’t obviously provide direct patient care,
but we definitely have a huge part in assisting the clinicians that do,” she says. “We’re an important part of the
team and add value to the whole process. We can impact
the patient care without providing it directly.”
With limited funds and personnel, Milford Regional’s IT division has managed to secure multiple grants,
help its clinicians provide great patient care, and play
a key role in the organization to reach Stage 6 recognition. That would be quite an accomplishment for a fully
funded and staffed organization, but Milford has proven
limited resources don’t have to mean limited success.
“I think you have to look at what you have available
to you and just try to achieve what you set out to do,”
she says. “We have a talented, dedicated team, and we
leveraged our investments that we already had in place
to make our systems workable for our clinical staff and
secure for our patients, and to show that we can really
use technology in a meaningful way.” AHL

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105

IMPACT

Strategy’s

Playground
Pediatric care and IT unite to tackle population
health at Children’s Hospital of Orange County

AHL APR.MAY.JUN 2017

By Amanda Garcia

106

Bill Feaster was studying computer
science at the University of California–San Diego when the Vietnam War
began to escalate. His low number in
the draft lottery inspired his realization
that he’d much rather fix people than fight them, so
he decided on a new career and switched his major to
premed biology.
It wasn’t until after completing medical school, two
residences, and two fellowships, though, that he circled
back to IT as he entered private practice in pediatric anesthesia and critical care at Children’s Hospital Oakland. In that first job out of residency, Feaster
couldn’t help but notice the hospital’s lack of information
systems. He turned his attention to the issue, and within
four years, Oakland had installed its first system.
A few years later, Feaster shifted gears again to earn
his MBA. He then moved to Sutter Health and spent
six years practicing pediatric and obstetric anesthesia
while directing its center for women and children services. His business knowledge was put to good use when
he accepted a position at Community Medical Centers
as senior vice president and chief medical officer, but
after three-and-a-half years in full-time administration,
Feaster was ready to get back to his patients.

BILL FEASTER
CMIO
Children's Hospital
of Orange County

Feaster accepted a position as a clinical professor of
anesthesia and pediatrics at Stanford University School
of Medicine, where his time was balanced between
faculty practice and hospital administration. That complementary role gave him the opportunity to implement
information systems and surgical IT support at the
hospital, once again combining his love of technology
and medicine. After ten successful years at Stanford,
Feaster moved once more to accept a full-time IT position as CMIO at Children’s Hospital of Orange County
(CHOC) in 2012.
CHOC’s mission is to nurture, advance, and protect the
health and well-being of children, and its vision is to be
the leading destination for children’s health by providing exceptional and innovative care. “We can’t provide
exceptional care without the resources to do it, and that
includes information technology,” Feaster says. By providing state-of-the-art IT, Feaster and his team support
both the mission and vision of the organization, enabling
the hospital to achieve its goals.
As CMIO, Feaster is responsible for assuring that clinical care is supported by IT through clinical information
systems such as EMRs and analytics. He also spends a
few clinical hours each week on his longtime specialty
of pediatric anesthesia.

IMPACT

“Strategy is a team sport created
in a participatory process with
input from many.”

pingmd is
privileged to work
with innovators
like Dr. William
Feaster who
are making a
diﬀerence in
healthcare and
guiding us to
support their
eﬀorts.

Feaster oversees a team of thirty-eight people—twenty-nine of whom focus on informatics, analysis, and
clinical records, and ten who focus on analytics and
interfacing with outside systems. But these days, Feaster
is most excited about the team’s work around population
health technologies.
One significant goal of CHOC’s current strategic plan
is to provide a full continuum of care for children not only
inside the hospital, but outside of it as well. This involves
a pediatric care system including components such as
financing, affiliated medical groups, and extended care
management, in the community. The breadth of a system
such as this is, in fact, the very definition of population
health, and Feaster and his team have been working with
partners and innovators to deliver it, including their creation of pediatric applications for Cerner’s HealtheIntent data platform.
“If you don’t know where you’re going, it’s sure hard
to get there,” Feaster says. To that end, he has honed
his skills in formulating and communicating strategy
throughout his career. He and his team are responsible
for the population health strategy at CHOC, and they all
work together to stay focused on strategic goals.
“But strategy doesn’t come out of a vacuum,” he continues. “It’s a team sport, created in a participatory process
with input from many.” Broad input casts a vision of what
the future could be, cultivates major buy-in, and drives
the team toward that future by developing multiple,
smaller strategies along the way.
Imagining the possibilities of future care for children
was the beginning of CHOC’s journey to population
health, and much of those possibilities were based on
new technology. “It’s important for technology to not
drive strategy or operations, but support them,” he says.
“Everything we do aims toward a shared vision.” Strategy
is what guides Feaster’s team as they walk to the future;
it makes sense of all their steps along the way.
Ultimately, Feaster’s personal goal is to combine his
passions for medicine and technology and provide care
for thousands of patients at a time by creating the most
value in crucial areas such as population health. As an
organization, CHOC is working hard to maintain the
health of its community’s youngest population—keeping
the healthy well, keeping the sick as healthy as possible,
and doing its best to ensure that patients don’t need hospitalization again (though CHOC will be there with open
arms if they do). “I can see that we’re making an impact
on this area of medicine, and it’s exciting,” he says. “It’s
what I’ve discovered is my calling, and I’m pretty happy
about that.” AHL

107

IMPACT

Going
CFO Laura Zehm is doubling
down on the population health
movement to help Montage Health
provide exceptional care at a cost
its community can afford

All

AHL APR.MAY.JUN 2017

In
108

By Stephanie S. Beecher

For some healthcare organizations,
keeping people out of the hospital may
seem counterintuitive. But at Montage
Health, promoting health outside of its
hospital walls is part of its philosophy.
It wasn’t always that way, though, for the nonprofit
healthcare provider based in Monterey, California.
Similar to other legacy healthcare organizations,
Montage turned its focus to internal interests—number
of patients treated, patient revenue, operating costs,
etc.—until around 2008, when community leaders
approached the hospital and urged the team to do something about the cost of healthcare.
That’s when Laura Zehm, CFO for Montage Health,
knew that it was time to steer major change. “We realized we were just kind of throwing patients over the
wall,” Zehm recalls. “We started talking about changing
direction to where we felt like we needed to go, which
was toward population health. We needed to do a better
job of serving the community, whether they were in our
house or not.”
This demand for change was growing evident
in-house, as well. Zehm says that over the years, she
watched as the cost of her own employees’ health plans
rose at steeper rates. She sought to find a solution to
alleviate their burden. After canvassing the country in
search of an innovative business model that could align
with Montage’s service mission, executive leaders landed
in Asheville, North Carolina, where a population health
program was successfully underway.

LAURA ZEHM
CFO
Montage Health

IMPACT

“We needed to do a better job of
serving the community, whether
they were in our house or not.”

Laura Zehm
whose outstanding work
has done so much to help
Montage Health and its
employees succeed.

Willis Towers Watson’s unique
perspective allows us to see the
critical intersections between
talent, assets and ideas — the
dynamic formula that drives
business performance and
success in hospitals and health
care systems.

willistowerswatson.com

AHLMAGAZINE.COM

“We looked for people that were ahead of us,” she
says. “The Asheville Project was a disease management
program based upon individual coaching and interventions. We added a wellness program to this effort.
These two efforts overlap, and, when deployed together,
resulted in a five-year flattening of our own health plan
cost curve. We definitely saw some success.”
Once Montage knew that population management
could work with its employees, Zehm worked with her
fellow executives to build a business model and presented it to the board. In 2012, the board approved measures to bring the concept to the community.
Montage’s population health initiative centers on key
partnerships with primary care physicians, specialists,
and case managers that provide individualized care. “We
have a population management company, where the case
managers are engaged with specialists, and they are
really good at calling on people and getting them engaged
in their own healthcare,” she says.
One of the questions that emerged included how to
best align Montage’s community health goals in a way
that was financially sustainable for local healthcare
providers. The health system needed to find a way to
get closer to the premium dollar so it was incentivized
to keep people out of the hospital, as opposed to inside.
The answer?
“We ended up building an insurance company,” Zehm
explains. “We wanted to partner since we did not know
anything about running an insurance company, but all
of the insurance providers were dealing with healthcare
exchange issues. We also felt that we could not wait. So,
if our goal is to keep people out of the hospital, then we
needed to find a financial model sustainable enough for
our own system.”
As a result, Aspire Medicare Advantage Insurance
launched in 2014. It was an unusual brainchild for a
healthcare system, and something that wasn’t always
an easy sell for Zehm, who took the reins as CEO at the
insurance subsidiary.
“When we first sold the idea to the board, they said,
‘Let me get this straight; I started on the board of a hospital, and now I’m on the board of an insurance company,’”
Zehm says. “They were asking why we were doing it and
how. With the rapid rate of change, we need to continue
to inform, communicate, and educate.”
Zehm says she stressed that if Montage didn’t take
control, someone else would—and they probably
wouldn’t favor the end result. “I went through this litany
of what would happen if we didn’t do it,” she says. “We
could be commoditized. Then we’re fighting and scrapping, and maybe getting worse and worse deals, and then

the community would blame us for it. It was
scarier to think about the future without
doing something like this. That’s why I have
so much passion for it.”
It’s a passion that has endured for more
than thirty years, when Zehm first came
aboard at Community Hospital of the Monterey Peninsula as a reimbursement specialist.
Zehm says the health system has offered her
growth and the opportunity to be innovative.
Switching Montage’s focus to population
health was admittedly a risky transformation. But still, Zehm says the organization is
“going all in” on its population health plan.
She points to the success stories that have
emerged from case managers, which prove
they are heading in the right direction. Today,
Montage Health is the nonprofit parent of a
family of companies, including Community Hospital of the Monterey Peninsula,
Community Health Innovation, Peninsula
Primary Care, and Aspire Medicare Advantage Insurance.
“We hope to change the way that healthcare is delivered in Monterey County,” she
says. “The healthcare system is designed to
address healthcare in a holistic way, meeting
people where they are in their health status
and helping them to stay healthy, manage
their disease, and to help them manage the
healthcare system.” AHL

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When Rogers Memorial Hospital first
opened its doors in 1907 as the Oconomowoc Health Resort, understanding
of mental health and how it should be
treated was fairly basic. Even so, the
health center based in Oconomowoc, Wisconsin, did its
best to provide patients with the era’s most innovative
mental healthcare treatments.
More than a century later, Rogers Memorial Hospital
is the anchor of the Rogers Behavioral Health System, a
fast-growing nonprofit behavioral healthcare provider
that, at its core, provides services for children, teens,
and adults suffering from disorders such as obsessivecompulsive disorder, anxiety, depression, addiction, and
eating disorders. To say that the health system has come
a long way from its early days of offering hydrotherapy
is an understatement: today, Rogers is one of the largest
behavioral-specific health systems in the Midwest and
the largest in Wisconsin, serving about 17,000 patients
every year.
One of the key players pushing Rogers forward is
CFO Michael Hedrick. Since joining Rogers Behavioral
Health System in 2013, Hedrick has helped lead the
charge in executing a growth and development plan, in
addition to guiding financial strategy, capital formation,
and IT infrastructure.
Hedrick uses his extensive experience in advising
growth firms to bring mental health services to more
people. He believes that there are three major obstacles that individuals with behavioral health issues face:
societal stigma, funding shortfalls in the field of behavioral health, and denial by those affected that they have
a treatable condition.
“My role here has been to facilitate a growth and development team, and to implement and support the vision
they have and the services the organization provides. I
can’t run the units or do therapy, but I can certainly help,”
Hedrick says. “Blessed is the word. It’s a perfect fit. Here,
I get to contribute to something that has meaning.”

AHLMAGAZINE.COM

Sara Stathas

By Sarah Kollmorgen

111

112

Even in the past three years,
Rogers has benefited from Hedrick’s
expertise as it underwent rapid
growth, increasing days of patient
care by 67 percent to in excess of
about 200,000 annually. One of the
projects Hedrick is most excited
about is the spread of Rogers Behavioral Health clinics throughout the
country. Although based in Wisconsin, Rogers has recently opened
clinics in Chicago, Minneapolis,
Tampa, Florida, and Nashville, Tennessee. Rogers is also considering
expanding to markets on both the
East and West Coasts in the future.
For the 2016 fiscal year, Rogers
recorded more than 17,000 admissions across its fifteen locations.
Although Rogers’s expansion may
seem rapid, Hedrick sees growth as beneficial not only to
the growing number of people the organization is able to
treat, but also to Rogers’s employees themselves.
“If your organization isn’t growing and pushing in
new directions, then your staff becomes stagnant,” he
says. Pushing growth and improvement ensures that
employees are engaged and see a future with Rogers.
“Having positive energy in the workplace also helps our
staff maintain the emotional resiliency to be at their best
with our patients and give them compassionate care.”
Compassionate care is crucial at Rogers, which is why
the company has focused on the quality of its growth,
as well as its geographical spread. Hedrick says one of
Rogers’s biggest initiatives recently has been building
up its IT infrastructure. In other words, Rogers has gone
digital. In July 2016, Rogers became the first standalone
acute psychiatric hospital to achieve HIMSS Stage 6
with an EHR system. “We are probably going to end up
with one of the most advanced IT systems in behavioral
health,” he says.
Rogers essentially revamped its information systems
from the ground up, replacing each piece of equipment in
the health system, as well as wiring in nine new locations
to ensure the entire system is connected through a highspeed bandwidth.
Hedrick’s team was also able to implement an electronic financial system, thereby effectively pulling billing
out of the paper age. Not only are 94 percent of bills now
electronic clean claims, Hedrick says, but Rogers can
now also compare financial data to other electronically
collected data. For example, Rogers can compare billing
data to cost information to create financial statements
for each individual program at Rogers, meaning that the

In addition to
his CFO duties,
Hedrick has
played a major
hand in the IT
infrastructure
at Rogers
Behavioral
Health
System.

hospital can analyze how an eight-person Sunday night
anxiety group is doing from both a financial and census
standpoint.
“Coming from outside the healthcare industry, I found
that the whole revenue cycle is an amazingly complex
piece of work,” he says. “A misstep anywhere in the
process has a ripple effect that can really create problems. You have to make sure from the moment you start
talking to someone about how you can help them that
everything is done right. Prior to joining Rogers, I had no
idea how much effort and technology went into getting
that part right.”
Patients and employees at Rogers Behavioral Health,
however, can rest assured that Hedrick will get it right.
Although the CFO is quick to commend members of
his team for their vision and hard work, Hedrick’s own
passion for working at Rogers and supporting its mission
comes across clearly.
“When I look back at what we’ve done in the past three
years, it far surpasses what I’ve done in the prior twenty,”
he says. “It’s good to be on the side of the angels.” AHL

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AHL APR.MAY.JUN 2017

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Building
Special
Asembia CEO Lawrence Irene expands on the specialty
pharmacy company’s evolution and its annual summit,
the largest US event of its industry
By Adam Kivel

AHL APR.MAY.JUN 2017

Connections
114

From the start, Asembia was an organization with family in mind. Founded
as Armada Health Care in 2004 by brothers Robert and Lawrence Irene and their
father, Sandy, Asembia’s focus is in the
specialty pharmacy segment and offers comprehensive hub services, pharmacy network management,
group-purchasing services, innovative technology platforms, and more.
This is to say, Asembia brings strategic solutions and
leading-edge products and services while maintaining a
high-touch sensibility. Asembia’s work in the pharmacy
industry optimizes patient care and outcomes, while
always considering the person behind the technology
and medicine. This can be difficult considering the
complex specialty therapies in which it works, but the
Irene family’s dedication, empathy, and professionalism
are paramount in assuring the comfort and health of the
patients Asembia can affect. Its patient support and hub
services ensure that the optimal patient and prescriber
journey is achieved and therapy goals are met. This also
includes its specialty pharmacy network, which spans
specialty, retail, and health system pharmacies across
the country, as well as their full-service group purchasing
organization.
Throughout its diverse work, Asembia remains passionate in providing opportunities for the professional

IMPACT

LAWRENCE IRENE
CEO
Asembia

growth and advancement of its own employees and other
medical professionals. One example of this dedication is
the 2017 Specialty Pharmacy Summit, which will be held
from April 30 to May 3 in Las Vegas. The annual event
is the largest US healthcare conference focused on specialty pharmacy and will feature thousands of attendees,
ranging from payers and drug wholesalers to pharma/
biotech manufacturers and pharmacy providers.
AHL spoke with Asembia CEO Lawrence Irene about
the evolution of Asembia, its goals for the future, and the
effect that the Specialty Pharmacy Summit can have.
What were some of your major goals for the organization at its foundation as Armada in 2004?

How have those goals evolved over the years?
Irene: All these years later, the goals remain the same.
The company continues to focus on supporting our
pharmaceutical manufacturer and pharmacy partners
and their efforts to help patients fulfill their specialty

What are the most interesting changes that the organization has undergone in its twelve years?
Irene: The industry has changed and so have we, including our brand. This year we rebranded our organization
as Asembia. The timing was right, and we wanted our
brand to reflect the technology-centric company that we
have become. We are still anchored by our pharmaceutical relationships as a group purchasing organization,
which has helped us grow our pharmacy network to more
than 30,000 retail, specialty, and health-system pharmacies nationally.
Over the last few years, the necessity to manage
patients taking specialty medications has given birth to
the high-touch patient services model (HUB) we provide
as well. We have invested in these HUB services as a way
to improve patient care through adherence and compliance. We employ pharmacists, nurses, and certified technicians to ensure that patients receive the highest level of
care available. Behind all of our services is the backbone
of Asembia: the technology.

AHLMAGAZINE.COM

SeaLight Entertainment

Lawrence Irene: The main goal was to create efficiencies between pharmaceutical manufacturers and a group
of specialized pharmacies and their patients. This was
the basis for the creation of the trade class known as specialty pharmacy today.

medication needs. The solutions, however, are now
rooted in technology and trying to solve for efficiency,
cost effectiveness, timely delivery, and recording all
applicable data points in this high-touch prescription
delivery and patient services environment.

115

IMPACT

The Asembia1 Specialty Pharmacy Workflow Platform
is what connects all specialty entities together. From
the manufacturer, the pharmacy, the prescriber, and the
patient, Asembia1 is the premier technology solution for
pharmacies to provide visibility into the life cycle of a
prescription and the standard for capturing all patient
interaction. Showcased at the 2015 Specialty Pharmacy
Summit, Asembia1 has quickly become the industry
standard and is the specialty technology powering pharmacies across the country.
What is Asembiaâ&#x20AC;&#x2122;s place in the specialty pharmacy
industry?
Irene: We consider Asembia to be at the center of the
specialty pharmacy industry, working with all pharmaceutical entities to advance the level of care for patients
in need of these complex therapies. That was true at our
founding, on a smaller scale, but within the middle of the
industry nonetheless. The industry was in its infancy
stages, and we were determined to positively impact the
marketplace through our unique services and solutions.
Tell me about the conference Asembia launched,
which is now known as the Specialty Pharmacy
Summit. What need does it meet in the industry?
Irene: What started as a small meeting of fewer than
ten pharmacies in 2004 has become the premier specialty conference and expo event annually. With more
than 5,000 attendees and representation by virtually all
specialty stakeholders, the summit drives collaboration,
education, industry trends, and innovation.

AHL APR.MAY.JUN 2017

How has the conference positioned both you and your
company as leading voices in the industry?

116

Irene: We have always felt that the Summit acts as an
incredible catalyst for industry growth, collaboration,
and shared voice. It is hosted by Asembia for the betterment of the industry and the advancement and improvement of specialty care that all stakeholders provide.

â&#x20AC;&#x153;We consider Asembia to be
at the center of the specialty
pharmacy industry, working
with all pharmaceutical entities
to advance the level of care for
patients in need.â&#x20AC;?
Could you give me a rundown of the immediate and
long-term future plans for the company?
Irene: We continue to expand our contracting programs
and services here at Asembia, and we are also continually investing in and launching enhancements to our
Asembia1 technology platform and patient services/
support capabilities. The specialty pharmacy industry
is constantly evolving, and we too are evolving to keep
pace with the incredible innovation this segment of
healthcare has been experiencing. We continue to hire
talented individuals that have immediate impact here
at Asembia and expand our incredible patient support
services staff to support new programs and expanded
partnerships that positively impact the patient journey.
With new specialty drugs coming to market at a tremendous pace, we understand the importance of providing white-glove service along with end-to-end solutions
that will positively impact outcomes for patients. We feel
we are strongly positioned to continue to play a critical role in the care continuum in this regard. We look
forward to continually building upon our strong partnerships while also developing new ones with leading
pharmacies, pharmaceutical and biotech manufacturers, payers, and other industry stakeholders to support
patients who require complex therapies. AHL

YES
Profile shares the stories of the modern executive.

THAT MEANS YOU
Share your story of exceptional leadership
with our network of powerful business leaders.

For editorial consideration, contact info@profilemagazine.com

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“As I was lying in
the cath lab having
an angioplasty, I
thought, ‘You
know, I’m awfully
glad I helped build
this place.’”
P. 167

PROGNOSIS

PROGNOSIS

The Cancer
Moonshot has
Attorneys
Mariam Koohdary helps AstraZeneca usher its pipeline of lifesaving
pharmaceuticals through FDA approvals and beyond

AHL APR.MAY.JUN 2017

By Russ Klettke

120

PROGNOSIS

makes her sound less like a lawyer and more like a scientist. In fact, she is the daughter of now-retired medical
professionals (her mother was a nurse and her father a
physician), and she has a natural affinity for biology and
chemistry. Koohdary even combined a political science
major with premed studies in college, but her father
encouraged her to choose law over medicine.
After graduating from law school at Temple University, Koohdary clerked for a federal judge at a time when
the dockets happened to be filled with patent disputes
that were coming to trial. She was intrigued not only by
the legal nuances, but also by the novel scientific concepts that gave rise to disputes in the first place. “I saw
the importance of science in advocacy,” she says. “And I
loved the combination.”
At AstraZeneca, Koohdary supports teams across the
three main phases of the pharmaceutical life cycle: the
research and development, launch, and the postlaunch
periods. Each has its own challenges, its own set of problems to solve, occasional disappointments, and some true
success stories.
Generally, the legal team first engages with investigational products when they reach the human clinical trial
phase. For example, the rules around informed consent
for patients who participate in trials are stringent, so
management of the legal-regulatory requirements must
be similarly tight. When those trials prove a new compound to be safe and efficacious, a genuine excitement
builds among Koohdary’s legal team as much as with

Medical breakthroughs that were once
thought of as impossible are becoming
realities every day. At the same time,
these breakthroughs are fundamentally
changing the way professionals treat
some of the world’s most devastating diseases.
For Mariam Koohdary, deputy general counsel at
global pharmaceutical company AstraZeneca, this is a
major aspect of what motivates her work­—not to mention
the work of about 3,000 AstraZeneca researchers who
work with a $1 billion annual budget, individuals whose
work Koohdary and her legal team help support.
The company’s work focuses on respiratory and
cardiovascular-metabolic conditions, as well as
oncology, but AstraZeneca’s approach to fighting cancer
also includes applications of immunotherapy. This falls
under one of the ten recommendations to come out of
former President Barack Obama’s Cancer Moonshot
project (managed by the National Cancer Advisory
Board, a federal agency in the Department of Health
and Human Services).
“We are finding ways to use our own immune systems
to attack cancer cells,” Koohdary says. Other approaches
the company takes include developing therapies that
target specific mutations to attack cancer cells, which
block tumor cells’ DNA-encoded ability to reproduce, and using antibody-drug conjugates that direct
cancer-killing agents to target specific tumors.
To hear Koohdary describe what the company is doing

121

PROGNOSIS

ASTRAZENECA PRESENTS
BREAKTHROUGHS IN CANCER
MEDICATIONS
This past fall, AstraZeneca—along with its global
biologics research-and-development arm, MedImmune—
showcased the potential of a variety of cancer medicines
through forty-six scientific presentations at the European
Society for Medical Oncology (ESMO) 2016 Congress in
Copenhagen, Denmark.
AstraZeneca also reported progress in advanced breast
cancer research and is addressing the need for treatment
advances in this area. According to the biopharmaceutical
and pharmaceutical company, about 30 percent of women
with early breast cancer go on to develop advanced/
metastatic disease, with median overall survival of two
to three years. Although advanced breast cancer (Stage
III/IV) is generally incurable, it is still treatable, and the
goal is to improve both the length and quality of life for
patients, according to AstraZeneca’s news release.

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AHL APR.MAY.JUN 2017

When clients with the resources to hire
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scientists. “This is when
we get more involved
with our business teams
Faslodex—also known as fulvestrant, a recommended
and regulatory agencies
medicine for the three-quarters of women with advanced
around the world who ask
breast cancer whose tumor carries the estrogen receptor
questions about our data,
(ER)—is the only hormone therapy for advanced/
which ultimately leads
metastatic breast cancer that slows tumor growth by
to the approved label in
binding to and degrading the ER, according to the news
release. “Faslodex has over ten years of clinical evidence
each respective country,”
to support its use, and we are continuing to evaluate
she says. As the medicaits full potential in advanced breast cancer, where we
tion gets closer to launch,
believe patient need is currently the greatest,” said Sean
Koohdary’s team goes to
Bohen, executive VP, global medicines development and
work with the marketchief medical officer, in an interview with BusinessWire.
ing and communications
"AstraZeneca has a long, rich heritage in breast cancer
research. We remain committed to investigating
teams at AstraZeneca
innovative potential medicines for the treatment of
to ensure messaging to
women with all types of advanced disease."
medical professionals
and patients is in keeping
with the regulatory directives and the scientific characteristics of the medication.
The bulk of the third phase of her work, post-launch,
is managing the company’s litigation, which can include
product liability lawsuits. Koohdary had the sizable legal
task of managing a large class action suit a few years ago.
She says there were hundreds of lawyers, scientists, and
other experts involved. More than 20,000 individual
patients joined the mass tort, and aside from the huge
financial exposure in the case, she had to make strategic decisions that sometimes overrode counsel that had
more seniority than she did.
“From day one, I was often the youngest person in the
room,” she recalls. The matter progressed over several
years, a time in which she had to manage both the litigation itself and help educate internal stakeholders on
how to navigate the business environment while it was
pending. She says the litigation helped hone her leadership skills. “I have always preferred to be considered just
one member of a broader team, and that litigation helped
me learn a lot about the importance of having diverse
views on issues, but ultimately to make a decision and
stand by it,” Koohdary says. “While those decisions were

Williams & Connolly
congratulates our friend and
client Mariam Koohdary for
her extraordinary contribution
to AstraZeneca and the legal
profession. We proudly join
with American Healthcare
Leader in recognizing her
tremendous success as a
healthcare attorney.

Am Law 2015 "A-List” Firm
Named to prestigious list of 20 “best in show” firms in the nation, The American Lawyer, 2015
Rated #1 litigation firm in Washington, D.C.
Chambers USA: America's Leading Lawyers for Business (2016, 2015, 2014)
Ranked Among Top 50 Elite Trial Law Firms Nationally
The National Law Journal, 2015

“Taking the time
to say ‘thank
youʼ for hard
work and effort
is something
that not
enough leaders
prioritize.”

124

ultimately mine, getting there together
was important to me. I also learned the
value of true collaboration. Fundamentally, all teams want to feel that they are
part of something bigger than themselves
and that every member is important and
has something valuable to contribute.”
While Koohdary also respected and
valued what she heard from outside
counsel, she says that she frequently
held different views. She explains that
in-house lawyers generally have a better
perspective of a company’s ultimate
strategy as a whole and will come to different conclusions and decisions as a
result. The case ultimately went to trial
and AstraZeneca prevailed.
Koohdary is quick to credit her legal
staff, some of whom work out of the
United Kingdom, Sweden, and various
other countries. Leading such a large
and diverse team requires building trust.
“Keeping my word is important to me,
and taking the time to say ‘thank you’ for
hard work and effort is something that
not enough leaders prioritize,” she says.
“Finally, being honest is critical, which
includes providing real and meaningful
feedback, both positive and constructive.
Almost everyone wants to improve their
skills, but most people don’t naturally
take the time to seek feedback.”

PROGNOSIS

She also tells young lawyers interested
in healthcare and pharmaceutical law
that this is as good as it gets.
“There are different, challenging legal
issues in this industry. It’s highly regulated, with different rules everywhere
in the world. But I feel like I am part of
an important mission, one that constantly offers different puzzles to solve,”
Koohdary says. “What I love most is being
surrounded by incredibly smart people
who challenge me and help make me a
better lawyer and leader.”
Koohdary might be working with
a lot of smart lawyers and PhDs, but
ultimately, her task is about patients
and advancing science. “I can’t wait to
see what the future holds for both our
approved medicines and those in our
pipeline,” she says. “After all, it's not
really about the law, it's about the science
and the patient.” AHL

partnerships

Ice Miller LLP is proud to bring its dedicated and committed lawyers to work with Mariam Koohdary and the
entire AstraZeneca legal team. Ice Miller shares Mariam’s dedication to vigorously defend AstraZeneca’s
products in a cost-efficient and creative manner so that
AstraZeneca may focus its resources on the science-led
innovation which is transforming the lives of patients
around the world.

McCarter & English, LLP congratulates Mariam Koohdary
for being recognized as a leader in the healthcare and
pharmaceutical industry. We appreciate the opportunity to work with such a talented attorney and leader,
and we look forward to continuing our longstanding
relationship and working together to help AstraZeneca
achieve its goals.

We salute Mariam Koohdary and proudly join
American Healthcare Leader in honoring her
leadership at AstraZeneca and
her outstanding career.
Chicago Cleveland Columbus DuPage County, Ill. Indianapolis New York Washington, D.C.

icemiller.com

Ice on Fire

AHLMAGAZINE.COM

Williams & Connolly is proud to have worked with Mariam Koohdary for many years and congratulates Mariam
for her accomplishments and success as a healthcare
attorney. As head of the US legal team overseeing its
litigation, Mariam brings extensive experience, exceptional judgment, and tremendous common sense to
her work. We applaud Mariam for her extraordinary
contribution to AstraZeneca during a period of constant
change in the healthcare industry. We proudly join in
celebrating Mariam’s career and look forward to her
continued success.

Congratulations to
Mariam Koohdary of AstraZeneca

125

PROGNOSIS

A Whole New Area
of Expertise
James Brady and David Young of Kaiser Permanente
shed light on the function of the company’s unique but
crucial area information officers
By Amanda Garcia

he entities of Kaiser Permanente
(KP)—a multifaceted organization made
up of the Kaiser Foundation Health Plans,
Kaiser Foundation Hospitals, and Permanente Medical Groups—are spread out
across seven different regions. One of these is Southern California, which itself is split into smaller groups,
referred to as service areas. As area information officers
(AIO), David Young and James Brady oversee two of
these areas in a one-of-a-kind position at KP; Young is
responsible for San Bernardino County, Brady for Orange
County, and both have their hands full with technology,
strategy, business leadership, workplace development,
and supporting Kaiser Permanente's vision.

T

You both have the unique title of area information
officer. What was the impetus behind the creation of
that role?

AHL APR.MAY.JUN 2017

James Brady: There are about 6,000 people in the
IT organization at Kaiser Permanente, and there are
three tiers of information officer roles: the enterprise CIO, eight regional CIOs, and twenty-one local
medical center/service AIOs. As AIOs, we service the
local areas, and each AIO has a large span of responsibility—often greater than that of a traditional CIO.

126

David Young: For example, my team in San Bernardino
supports 15,000 computers, 1,000 physicians, and about
8,000 employees. I have two hospitals and sixteen offsite clinics, and Jim has two hospitals, twenty-three
clinics, and one building in process in Orange County.
The position was created in 2009 by our regional VP, Jim
Crawford, with the intent that AIOs would serve as local
CIOs and as integral members of business leadership at
that level.

PROGNOSIS

What makes the AIO role unique to a traditional CIO
position?
Brady: Traditionally, the CIO has oversight over all
technology resources and staffing and full control of
technology strategy. But at KP, we have a national entity
and regional technology entities that are delivering
applications and support. Our role is to act as peers and
technology partners with all local medical center leadership teams—physicians, nurses, and administration—and
be their single point of contact to help develop strategy
at the business level for their particular medical center.
Between 60 and 70 percent of our time is spent providing insight, translating technology needs, and providing
value to the business. We then interface back with the
various KP technology enterprises and regional teams
to make their vision a reality.

JAMES BRADY
Area Information
Officer
Kaiser Permanente

Young: Because we serve as business leaders, we take on
more than only technology. For example, I have a passion
for workplace development, and Jim is really involved
with innovation. The AIO role allows us to expand those
passions as business leaders.
How does your AIO role support the priorities and
overall mission of Kaiser?
Brady: Our mission at Kaiser Permanente is to provide
quality healthcare so all members can live happy and
healthy lives. As AIOs, our goal is to partner with the
local business to develop their strategy and vision and
then enable them to achieve it. All of our roles are truly
integrated—doctors, nurses, administrators, technicians,
etc. And we’re all in the room together, collaborating and
problem solving, so it’s very relationship-based. Nobody
can reach our goals alone, so we contribute by bringing
our voices to the table.
How is your workflow structured?

“The next generation CIO—
which is what our AIO role
is becoming—is a leader that
is connected to the business
leaders theyʼre partnering with.”
JAMES BRADY

AHLMAGAZINE.COM

Young: It’s a tremendous amount of performance. Right
now, we have 120 projects in my area going at once.
There are the usual incidents and work orders within
our respective areas, but we also get a lot of projects
from outside, so it comes down to maintaining a master
project list and providing resources to finish our technology road map. And, as to Jim’s point about integration,
some of our staff are dotted line reports and some are
direct reports, so there is a lot of overlap and coordinating. I have seven direct reports, but the total support
team that I’m responsible for is sixty-five. We’re a highly
matrixed organization.

DAVID YOUNG
Area Information
Officer
Kaiser Permanente

127

PROGNOSIS

TEAM
WORKS.

It sounds organizationally complex.
Brady: Yes, but that’s another thing that makes KP
unique: in every area of the organization, the direct
reports may be small in number, but there’s so much
emphasis on the partnerships and greater support group
that the teams are actually quite large. In IT, for example,
we have groups for electronic medical records, imaging
and radiology, facilities, pharmacy, lab, and more, and
they all have IT components that all roll up to the AIO.
We also have an indirect relationship with directors in
hospitals and department administrators in medical
groups, and we collaborate with them at the VP level.
What makes your similar jobs unique to each other?
Young: We have different member and patient demographic needs, though both areas are growing strong.
I’m personally involved in a lot of workforce strategy
initiatives and community benefit opportunities. Jim
mentioned taking on initiatives at regional and national
level based on expertise, and for me, that initiative is
VOIP—voice over Internet protocol.

AHL APR.MAY.JUN 2017

Working together, our
doctors don’t just see
you. They see the
big picture of your
overall health. By
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128

Brady: And I’ve focused on strategy in our local medical
center technology road map development by identifying locally deployed applications where we should
have regional ones. I was also recently asked to take
over a project in the Hawaii region where we’re acquiring three hospitals and moving them to the KP system.
That’s another good example of participating in shared
regional and national initiatives: it’s about finding areas
where we can add value, and there are always niches that
need contributions.
What are some leadership characteristics that are
essential in your role?
Brady: It’s so important to understand that the next
generation CIO—which is what our AIO role is becoming—is a leader that is connected to the business leaders
they’re partnering with and supporting. We’re so relationships-based, so to be successful here you have to
build them. We live in a collaborative world, where
information is available to everyone and partnership is
required to get anything done. Understanding others and
being able to forge together the strengths we all bring to
the table is the key to furthering the vision of the organization. To be part of providing that high-quality care
is exciting.
Looking to the future, what do you see on the horizon
for Kaiser Permanente?
Young: Lots of my work outside of technology is based on
leadership development and workforce strategy. I’m passionate about this continued growth and development of
managers and emerging leaders and helping them grow
into their roles. I love seeing people move up just like I
did over the past twenty years, and I believe that investing in those up-and-coming leaders is what will keep us
strong for years to come. AHL

AHLMAGAZINE.COM

129

PROGNOSIS

Keeping an Eye on
the Horizon
As the executive VP and CIO for Merck, Clark Golestani uses
partnerships and the “three-horizons model” to increase
productivity, drive business, and leverage disruptive technology
By Urmila Ramakrishnan

Clark Golestani says his job has three
main focuses: operations, helping to
drive the business, and leveraging disruptive technology. For these, the executive
VP and CIO for Merck uses a technique
called the “three-horizons model,” which helps him
manage his cost structure, partner with other companies to support business objectives, and drive innovation.
Golestani spoke with AHL on this strategy and what it
means for Merck, a global healthcare leader.
Can you explain what the three-horizons model is and
how it has benefited Merck?

AHL APR.MAY.JUN 2017

CLARK GOLESTANI
Executive VP, CIO
Merck & Co., Inc.

130

Clark Golestani: The three-horizons model is a McKinsey business model that we adapted and applied to
IT. We used the three-horizons model with a couple of
extensions that help us manage our risk, as well as drive
the business-operations function across the entire corporation for IT. There are some really interesting debates
out there about whether a CIO is really a chief technology officer, and where their primary focus should be—
whether they should focus all their energy on being the
partner to the business and drive business results, shift
the productivity equation, or drive innovation across
the organization. My argument is that a CIO needs to
do all three. You can’t just do one or the other, and that’s
the reason we structured IT around the three-horizons
model. It allows us to get that accomplished.

AHLMAGAZINE.COM

131

PROGNOSIS

“Technology innovation is never a static
thing. It’s never a point in time. It never
ends. I believe that the question is just:
what’s around the corner next?”

MERCK EXPLORES OPTIONS FOR BLOCKCHAIN
WITHIN HEALTHCARE
When it comes to innovation in healthcare, something like
blockchain could be used in making advances within vaccine
registries or transactional histories for patients, as well as being
paired with a patient’s current EMR to provide a new level of data
integrity. It’s also one avenue of technology that has more than
intrigued Merck CIO Clark Golestani and his team.
Last summer, during the MedCity News CONVERGE conference
in Philadelphia, Nishan Kulatilaka, associate director of product
management and applied technology at Merck, explained that the
blockchain is a distributed system, where every node has a ledger
of everything that happens. “You get a new level of transparency
where you can verify what happened,” he said.
A blockchain is a type of distributed ledger comprised of
unchangeable, digitally recorded data in packages called blocks.
These digitally recorded “blocks” of data are stored in a linear
chain, and each block in the chain contains data (e.g., bitcoin
transaction). These blocks of hashed data draw upon the previous
block in the chain, ensuring that all data in the overall “blockchain”
has not been tampered with and remains unchanged.
“There’s something really cool about having your record follow
you wherever you go without needing that data on you at all times,"
Kulatilaka said. "You’re no longer bound to your hospital system.”
Merck’s applied technology group is now exploring potential
applications for the blockchain approach within the healthcare
field. After the financial services sector, Kulatilaka explained,
healthcare could potentially be the second-biggest industry to
adopt this blockchain technology.

AHL APR.MAY.JUN 2017

While the healthcare industry may not be making moves to
blockchain technology in the immediate future, MedCity News
reports that the technology will be implemented more widely over
the next five years.

132

You will hear a lot about money and investment for
innovation. Some CIOs say that they can’t innovate
unless they get more money. My perspective is that the
CIO should have the mindset of a CEO of technology. If
you think like that, the first thing you’re going to do is
not ask for more money; you’re going to figure out how to
drive optimization to accomplish all the goals. And that’s
what we did at Merck. We structured the IT organization
completely along those three horizons when it comes to
cost structure.
When you do, for example, you end up with a part of the
organization that wakes up every day focused on driving
service levels up and cost down. They operate at scale—
that’s their purpose. They innovate, just like the rest of
the organization, but the innovation they apply is really
to drive the productivity of the IT operations function,
if you will. That’s not just cost infrastructure, but really
operating of all IT assets. That frees up some money, and
the focus of the rest of the organization is to partner with
all the business areas and drive productivity.
This is how we take costs out while driving performance up, support colleagues through partnership, and
leverage disruptive technology. When you look at our
ability to invest and drive productivity innovation, we
exceed many of our peer companies.
What’s your approach when it comes to partnering
with technology companies, particularly smaller ones?
Golestani: It’s like growing a plant from a seed. You
really need to give it a lot of tender, caring love and
make sure you don’t crush it. Big companies have a way
of crushing start-ups and small companies early because
they always have big problems that they want solved at
scale. The reality is that in order to let innovation grow,
you really have to protect it. That takes a very different
mindset. Big companies have the opportunity to partner
with a start-up—if they’re careful of the perspective and
the strategy of scaling. If you can take innovation and
apply it at a scale, you’re going to get great results from it.
One example of that is our partnership with Enigma IO,

PROGNOSIS

1

#

Life
Sciences

AHLMAGAZINE.COM

which is a small but fast-growing start-up
out of New York City. They do data mining
and data management on public data sets.
They were a very, very small firm when
we started working with them. Like any
large company, we could have given them
a hundred problems to start with. Instead,
we focused on one problem, and they did
great. Then, we expanded to two problems,
and three problems, and we continued
that expansion, being careful not to crush
that company.
We learned this early on when I was
working with some start-ups early in
my career. We actually gave another
company too much of the problem set and
demanded too much. We learned there
how to really drive a successful partnership, and it’s not easy by any means. The
reality is that when you’re driving innovation, you may have to solve your problem
through other means until that innovation
can really grow up. But if you do that, more
often than not you get a far greater value
proposition at the end.
For Merck, these are true partnerships
to solve business problems, not supplier
relationships like other large companies. Quite often, you are coaching that
start-up, directing them and educating.
That’s very different than, “You show
me what you’re selling, and I’ll tell you
whether or not that fits with the solution
I’m trying to achieve.”
I think it’s also important to recognize
that innovation is not just in the start-ups.
There are start-ups in large corporations
also. It’s important not to forget about
the major tech players because there’s
opportunity to really partner with them
and drive new levels of innovation.

133

PROGNOSIS

13
of
16

First
in
Class
Drugs*

AHL APR.MAY.JUN 2017

Developed by

134

* Drugs approved by FDA in 2015

“My perspective is that the CIO
should have the mindset of a
CEO of technology.”
How do you define technology’s influence on Merck’s
digital health innovation?
Golestani: Today, there’s really a crossover and blending
of information in data sciences with health sciences, so
there is an underpinning of technology capability that
really fits with any of the innovation capabilities that
come to market. That certainly influences where we
invest and where we don’t. Merck has a health-related
venture fund that is aligned to our strategic core direction of the company. It also has a Healthcare Services and
Solutions subsidiary that allows us to take advantage of
some of these new technologies while leveraging some
of the corporate resources.
It is important to remember, though, that technology
innovation is never a static thing. It’s never a point in
time. It never ends. I believe that the question is just:
what’s around the corner next? The one area that gets
me most excited for what’s around the corner next is
blockchain technologies. There are opportunities to
really streamline costs across the healthcare ecosystem
and ways of protecting privacy that are hard to realize
with other technologies. I believe there are ways of liberating patient data while also giving patients even greater
control over their data to really drive and fuel research.
In the end, patients can have better solutions and better
therapies to many things that afflict so many people. AHL

Cognizant congratulates Clark Golestani on being recognized as an industry leader. At Cognizant, we partner with our clients to create new business
models and build the infrastructure, processes, and platforms necessary to
power digital success. We are honored to advise and support Merck on its
journey to become the industry’s premier, research-intensive biopharmaceutical company, and to make a difference in the lives of people globally
through its innovative medicines, vaccines, and animal health products. We
wish Clark Golestani and Merck continued success and look forward to continuing our partnership.
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PROGNOSIS

From Vital Signs

As a former ob-gyn specialist, Sheryl Bushman brings
a clinician’s perspective to medical informatics
By Jeff Silver

heryl Bushman knew she was going to
be a physician when she was just five
years old. Her mother had given birth to
a younger sister, but the infant’s lungs had
not formed properly, making it impossible
for her to breathe. Bushman decided then that she would
go into medicine so she could save lives and help parents
avoid the grieving she saw her mother go through after
the loss of her newborn sister.
Bushman followed through on that promise, ultimately going into obstetrics and gynecology. What she
did not anticipate, however, was the turn that her caree
r took as a result of digital technology’s impact on healthcare. Today, she’s the CMIO at the full-service healthcare
consulting firm Optimum Healthcare IT, based in Jacksonville, Florida.
While practicing at a rural hospital affiliated with
the St. Louis-based Sisters of Mercy, Bushman learned
the EHR system that the nursing staff was using. Recognizing its value, she convinced the IT staff to create
templates she could use for her labor and delivery notes.
Soon after, they began to consolidate the two different
IT platforms that the ten Sisters of Mercy Hospitals
were using (including different versions of the software

AHL APR.MAY.JUN 2017

S

136

SHERYL
BUSHMAN
CMIO
Optimum
Healthcare IT

at various locations), and clinicians were invited to
provide input on capabilities and features that the new
system should provide. Bushman’s suggestions were so
helpful and insightful that the IT group offered her a job.
Although she resisted at first, she agreed to part-time
involvement, which grew into a full-time commitment
alongside her medical practice.
“I knew I had to choose between the medical and informatics focus and realized I could impact many more
people if I helped implement the IT solution,” Bushman
says. “I could make the system easier to use for all specialties, more transparent, and safer for patients—everything that an integrated, well-organized health record
can provide.”
With no formal IT training, Bushman became medical
director of clinical transformation and received seven
different certifications in the system’s software. She
brought to it a clinician’s eye: reviewing the “symptoms”
of a given issue, analyzing the environment in which they
occurred, and then developing appropriate solutions.
Bushman soon realized the importance of maintaining appropriate priorities when addressing informatics
issues, the most important being to stay focused on the
patient and the larger clinical picture. “Physicians have

PROGNOSIS

to Vital Infrastructure
“I knew I had to choose
between the medical and
informatics focus and realized
I could impact many more
people if I helped implement
the IT solution.”
bility to provide specific wording required to activate
CMS observation status, but displayed only for Medicare
patients. In another, functionality was implemented to
support monitoring and maintaining physician compliance with an Oklahoma requirement to update a public
record of prescriptions for scheduled medications.
For the best solutions, Bushman recommends not just
adding capabilities that users ask for, but instead asking
what they are trying to accomplish. “Fully understanding
the goal enables a good informaticist to provide several
options to achieve what users need and avoid unintended
consequences somewhere else in the system,” Bushman
says. “Solving those kinds of problems is the fun part of
the job.”
Once users become more familiar with a new EHR
system, it’s completely normal for unexpected issues to
arise. Bushman finds that the most successful responses
can be developed when the IT organizational structure
includes physicians and other key operational representatives. In the face of ongoing upgrades, maintenance,
and customizing to specific workflow requirements,
this is the kind of engagement, Bushman contends, that
is necessary to ensuring that EHRs contribute to patient
and organizational health. AHL

AHLMAGAZINE.COM

to remember that an EHR system has to be usable by all
providers and specialties,” she explains. “That means
understanding the overall clinical workload, the downstream impact of any changes we make, and keeping the
data accessible to patients who want information about
their own care.”
After leaving Sisters of Mercy, Bushman served as
CMIO at NYU Langone Medical Center, and then joined
Optimum Health in 2014. Throughout these various
venues, she has seen that a broad range of decisions must
be made at the outset of any project in order for an EHR
system to be successful. These might include determining who is responsible for completing transfer-orders
reconciliation or the percentage target for physician-entered orders in the system. “There are a million policy
decisions that affect care quality and compliance issues,”
she says. “If you don’t make them up front and decide
who’s responsible for a given factor at any given moment,
then no one’s responsible.”
According to Bushman, EHRs are not necessarily
time-savers, contrary to common misconceptions—especially during transitional periods such as implementations and upgrades. Their key benefits are in providing
transparency, so that routine questions only have to be
asked once, and allowing all different specialties and
departments to have access to the same information
on a single platform. Everything from updated problem
and medication lists to automated reminders for labs or
exams are all available through a few online clicks.
Bushman also refutes the idea that older practitioners
typically push back against newer technology. “Adoption
has nothing to do with age,” she says. “I’ve seen users of
all ages who are resistant at first or have trouble getting
acclimated, but once they understand the value the technology provides and their role in facilitating it, they all
adapt very quickly.”
Diagnosing issues and coming up with innovative
solutions are Bushman’s favorite aspects of her job. In
one instance, she led the team that developed the capa-

137

PROGNOSIS

A
Healthy
Pairing
David Lubarsky’s
experience and
expertise are playing
a big part in making
the University of Miami
Health System an
efficient, cohesive unit

AHL APR.MAY.JUN 2017

By Joe Dyton

138

Dr. David Lubarsky, a practicing anesthesiologist by trade, is living proof that
sometimes a role outside of one's specialty or expertise can still be a perfect
fit. For the last four-plus years, Lubarsky
has doubled as the leader of integration efforts for the
University of Miami Health System (UHealth).
In his chief medical and systems integration role,
Lubarsky has helped tie together numerous campuses
across the South Florida tri-county region. Since taking
the role, he has helped create a centralized scheduling
system for the hospitals and practice, improving the efficiency of supporting infrastructure and working with
critical project management at the hospitals in order to
improve performance.
On the surface, it appears to be a lot for one person to
take on—especially when they already have another job
running one of the largest departments in the country.
For Lubarsky, however, the end result makes it all worthwhile. “Anesthesiologists are really integrators to start
with,” Lubarsky explains. “When you look around, many
are serving as chief medical officers and other health
system integration roles naturally because they are
used to working with a variety of different specialists
and bringing people together in terms of operational efficiency and optimizing the delivery of care. Plus, I happen
to love problem-solving on behalf of a good cause.”

PROGNOSIS

DAVID LUBARSKY
Chief Medical,
System Integration
Officer
University of
Miami Health
System

“Being committed to local
change isn’t always enough;
we often need an expanded
view of what’s possible
around the country and that
can keep us all moving in
the right direction.”
AHLMAGAZINE.COM

The need for a role such as Lubarsky’s came as
UHealth evolved from a smaller, single-facility-focused
group to one that was constantly expanding across the
Miami-Dade and South Florida tri-county area in many
different hospitals and new outpatient facilities. As the
system continued to grow, there was no real plan in place
for how all of these sites should work together in order to
create a unified UHealth way of providing care.
“Whether it was managing care or scheduling patients,
internalizing policies or management procedures, we
were a group of siloed entities,” he says. “When a new
administration came in 2006, we began to realize we
really needed to work better together.”
That was the problem. But the solution came when
Lubarsky and his team decided to unify people across
UHealth who were more or less performing the same
tasks at a part-time level, rather than have a subject
matter expert put their full attention to a particular role.
The move paid off, as efficiency increased and operating
results improved without losing manpower or adding
additional expense.
“Nobody is really an expert, and everybody is spending
a lot of time and effort trying to do the best job they can
do,” Lubarsky says. “It was a matter of corralling the same
resources. You’re saying, ‘Hey, you’re now in charge of
this part of a portfolio across the system.’ This creates
a level of expertise that is a true resource and is much
better than having three people who are doing a job parttime that doesn’t get their entire focus.”
Lubarsky also conceptualized and developed an integration project for the University of Miami’s retail health
strategy. For him, the big takeaway and key to making
this project a success was understanding how committed
partners can develop a joint effort toward better health
coming at that care from different angles.
“When you put all the various opportunities together
and think outside the box a little, you realize that a partnership health strategy is not just a combination of
what you are doing, but building a platform to leverage
each other’s expertise and each other’s touchpoints for
patients,” he explains. “There’s a lot that each partner
brings to the deal that enhances the care both organizations can deliver inside and outside the walls of their
respective facilities.”
In other words, if the University of Miami was sending
its patients to a particular pharmacy, that pharmacy
would naturally do better. If that pharmacy is handling a
majority of the University of Miami’s patients, its health

139

PROGNOSIS

GROWING THE COMMUNITY OF CARE

AHL APR.MAY.JUN 2017

In a move to grow the number of people that the system can positively
impact, UHealth and partner Jackson Health System opened a new urgent
care center in Country Walk in southwest Miami-Dade in September. The
center is the first of an eventual six UHealth Jackson Urgent Care centers
planned to open throughout the Miami-Dade County. “UHealth is proud and
committed to working with Jackson to bring our excellence in healthcare
to more people in our community,” UHealth chief clinical officer and chief
operating officer Thinh Tran said at the facility's opening.

140

system can use those designated pharmacies to augment
population health initiatives around susceptible populations, whether they are lower income, less educated, or a
population with chronic disease. “When patients stay on
their medication regimens and check in with knowledgeable professionals about issues, their health is improved,
society spends less money overall, pharmacies make a
greater impact on patient lives and increase profits, and
health systems have a greater chance of succeeding in the
population health initiatives, which is key to succeeding
in a risk assumption world,” he says. “Everyone wins with
a dedicated and organized effort.”
Lubarsky adds that there’s a tremendous amount that
can be done in building a retail health strategy with the
right partner. “It doesn’t have to be a unique or exclusive
partner,” he notes. “You can have multiple arrangements.
In Miami, we’ve reached out to many different potential
partners in that pool.”
The initiative that Lubarsky may be most passionate
about, though, is moving toward value-based health.
When someone takes their car to a repair shop, they have
the expectation that they’ll pay an assessed fee and the
car will get repaired and stay fixed; Lubarsky feels going
to the hospital should be no different.
“If you come in for service—whether that’s a hip
replacement, congestive heart failure admission, or
pneumonia—we should fix it and we should make sure
when we send you out with your fixed heart it shouldn’t
break again,” he says. “The core value base is about
readmissions and bundled pricing. I believe that is likely
to be a continued focus, and that type of initiative is a
great way to get started on the volume-to-value road.
It certainly isn’t new; all service-oriented industries
operate this way. These initiatives associated with the
often maligned Affordable Care Act are actually moving
us all in the right direction.”
Even if value-based health becomes the rule more than
the exception, there will always be caveats, Lubarsky
explains. Upfront pricing, for example, should be taken
as an estimate depending on the patient’s circumstances.
Academic systems such as the University of Miami have

Alberto Jacir, assistant professor of family medicine at the University of
Miami Miller School of Medicine, oversees the medical direction of the
six Jackson Urgent Care centers. The plan was devised in order to offer
patients an option between traditional doctor appointments and emergency
room care, and the locations for these facilities were chosen for their
relation to areas that were previously underserved by urgent care facilities
or overburdened with a high population.
“UHealth and Jackson have demonstrated a commitment to bringing
academic medical care further into the community,” Jacir said in a recent
press release. “These urgent care centers will be uniquely positioned in
the neighborhoods where they’re needed most. Our strategy has its roots
in providing access to the two most influential healthcare systems in the
region under a consumer-based model, focusing on convenience, service,
and medical excellence.”
The remaining five locations are scheduled to open before the end of the
year, and will be open seven days a week, serving patients with illnesses
such as the flu, fever, vomiting, earaches, simple bone fractures, rashes,
and minor allergic reactions, as well as offering sports physicals and flu
vaccines. The facility will also be able to perform echocardiograms and
digital x-rays, while staff can conduct lab tests such as blood glucose,
urinalysis, and strep throat cultures.

a tougher time with pricing because, even when they
take good care of patients, what happens after they’re
discharged is out of the hospital’s hands. Sometimes
patients go home to environments that aren’t supportive
of good care, whether it’s because of a lack of resources,
knowledge, or just the inability to access additional care.
The buzzword now is social determinants of health,
and it is important. “Posttreatment care has to be taken
into account when the bundled pricing is being considered,” Lubarsky explains. “There are poor people who
may actually need a higher estimated price to reflect
their true cost of doing business for things that are out
of their control.”
Putting Lubarsky in this role has helped improve
UHealth in a number of ways, including a more efficient workforce and more cohesion between its hospitals, which has led to better care for patients. However,
Lubarsky is happy to admit that this role has been just as
good to him as well. The challenges that he encounters
make coming to work every day fulfilling, and he’s been
tapped along the way to fill a number of roles specifically

We salute the entire UHealth team for their health system
integration efforts and their strides in advancing value-based
healthcare in the Miami community.

At Eyman Associates, we
are committed to our clients’
work in transforming the
nation’s health care system
and making its benefits
accessible to all. With the
sophistication of a top tier
health care practice, yet the
flexibility of a boutique firm,
we provide a mix of legal,
strategic, and policy advice
to health industry leaders.

142

www.eymanlaw.com
202-567-6201

created for him to be a “fixer.” He has been a senior associate dean for safety quality and risk when a malpractice crisis was disabling the system; the first CEO of the
1,100-physician practice when it was facing an annual
loss of about $100 million a year; and the initial system
chief medical officer of the university’s $2-billion health
system as it began to address the value-based world and
meaningful use of its Epic EMR, as just a few examples.
“I’ve been very lucky. Every step of the way it’s been
great because I have been able to address what I think are
incredibly important initiatives that make it possible to
deliver better care, every day, to every patient,” he says.
And almost uniquely, he is publicly fond of working
with consultants, who are not always fully appreciated
at times by the health system rank and file. “When you
are constantly trying to invent something from scratch,
having some advice about how other aspirational organizations organized their efforts is a critical part of defining
your own path,” he says. “People always say that consultants simply tell you what you already know, but that is
because they aren’t asking the right questions. You may
know that you need a centralized safety and quality organization, but figuring out exactly how many FTEs to start
with, what is a reasonable timeline to deliver results,
and starting with matrixed central/local organizational
charts that have been successful elsewhere provide the
substance with which to engage all your internal stakeholders. Being committed to local change isn’t always
enough; we often need an expanded view of what’s possible around the country, and that can keep us all moving
in the right direction.” AHL
Ballard Partners’ health practice managing partner, Jan Gorrie, is proud to
work with David Lubarsky, chief medical and system integration officer, and
the University of Miami’s Miller School of Medicine. Over the past decades, it
has been exciting to be a part of the UM faculty practice evolution as a leader
in innovation and care delivery as it pursues its tri-fold mission of research,
teaching, and superb clinical care. Ballard Partners salutes Dr. Lubarsky for
his many contributions to the U!

Eyman Associates is pleased to join American Healthcare Leader in recognizing the inspiring leadership of Dr. Lubarsky. We are proud to partner with
the University of Miami and providers nationwide to improve the health-care
system available to all. To find out more about our legal and policy expertise,
visit www.eymanlaw.com.

PwC recognizes the vision and impact that Dr. David Lubarsky has achieved
in his role as chief medical and system integration officer at University of
Miami Health System. PwC was a solutions provider in supporting his efforts
to drive towards value-based care by building foundational and transformational elements of a population health and value management care delivery
model—addressing patient needs across the continuum of care. Dr. Lubarsky
has provided the opportunity to create and deliver innovative solutions that
combine strategy, clinical operations, and clinical analytics to create better
outcomes. His efforts to improving quality and clinical outcomes while managing the total cost of care clearly established his commitment to measuring and managing value for patients and the health care delivery system.
PwC looks forward to watching their journey towards value-based care as it
evolves in the near and long-term future.

PROGNOSIS

HE AL
The Patents That
We expect our pharmaceuticals to cure us, and we’re thankful to the people
of science who bring them to the market. But it’s lawyers like Dana Hubbard
who are indispensable for turning ideas into medicine.
By Russ Klettke

DANA HUBBARD
Head of Life
Science Patents
MilliporeSigma

But IP attorneys such as Hubbard do a lot more for
their employers than litigating patent infringement.
With a broad understanding of what already exists in
the marketplace or in the approval pipeline, they advise
senior management on where product gaps exist. And in
the case of Hubbard, he is so involved in the development
of products that his name goes on the patent.
Hubbard is a named inventor on eight patents to date,
with another dozen or so inventions in the patent-review
process. US patent law requires inventors to actually
conceive of the invention, not simply contribute to or
refine it. Hubbard’s degree of involvement meets these
requirements, and he is named on the patents in the short
list of inventors.
“This is not common, but it’s not unusual,” he says.
“We have brainstorming sessions on the conception of
the invention. Because I have a broad exposure to the
many technologies in the industry, I advise the other
inventors on what else is being developed.”
The knowledge required to be a named inventor of
highly technical methods—e.g., “methods for cleaning a
Protein A chromatography column employing a media
comprising a Protein A ligand derived from the C domain
of Staphylococcus aureus”—comes from Hubbard’s background in science. As with all attorneys admitted to the
patent law bar, he holds a science degree, a bachelor of
science in biology from the University of Massachusetts.

AHLMAGAZINE.COM

An important part of the sometimes-contentious discussion on
international trade agreements is the
matter of international respect for
patent protections. For healthcare professionals, this is not just a business matter, to ensure the
innovators are given their just due in revenue flow—it’s
also about patient safety.
Dana Hubbard, an intellectual property (IP) attorney who is head of patents for MilliporeSigma—the
life science business of Merck KGaA operating in the
United States and Canada—knows a great deal about
the subject. The global manufacturer of life science tools
for the pharmaceutical industry is not only a supplier to
the critical research, development, and manufacturing
functions at major pharmaceutical companies, (including its corporate parent, German-based Merck), but it
also invests heavily in research and development itself.
The “do no harm” part of the Hippocratic oath is a first
priority for the company. “We serve the largest companies in the pharmaceutical industry,” Hubbard says.
“They, and we, have to be very careful about the supply
chain.” Fortunately, the entire industry is getting more
methodical about product cleanliness, he notes. For
example, Chinese firms are bowing to legal and public
pressure to honor other companies’ patents and ensure
safer products overall.

A researcher uses a chromatography column containing chromatography
resin (left) and a control skid (right), used to separate and purify proteins
like monoclonal antibodies made and sold by MilliporeSigma customers.

Hubbard started his career with the company, which
at the time was known as Millipore Corporation, in 1997.
Since then, Millipore was acquired by Merck KGaA
(Darmstadt, Germany) and has made five acquisitions
of its own. Its product line has grown from about 60,000
filtration-based products for pharmaceutical product
development and manufacturing (and microelectronics,
which led to a spin-off in 2001) to today, when it offers
roughly 300,000 products and services including lab
water instruments, consumables and services, cell lines,
antibodies, microbiology and biomonitoring, test assays,
analytical reagents, and flow-cytometry kits and instruments. The clients for these have evolved over time as the
pharmaceutical industry has globalized and rationalized.
“The biopharma model has changed in recent years,”
Hubbard says. “It used to be that R&D was conducted
in-house. Now this is done by smaller start-ups, universities, and spin-offs from universities.” This contributes
to faster innovation because entrepreneurial ventures
that are fundamentally about R&D—for example, companies like Juno Therapeutics, MyoKardia, Spark Therapeutics, Apexigen, and Audentes Therapeutics—are not
distracted by externalities more typically characteristic
of larger corporations. Bigger firms still do some of their
own R&D, but quite often, they’ll outsource the function.
Hubbard knew he wanted to combine his love of
science with the law from a relatively young age. “With

PROGNOSIS

DANA HUBBARD,
LAWYER AND INVENTOR
Already named on seven patents, Hubbard has
about a dozen more awaiting approval by the
US Patent Office:

Conductive masking laminate

Relates to a conductive masking tape for
electromagnetic-interference-sensitive equipment

Congratulations!

Disposable mixing system

Relates to disposable mixers using cyclably
inflated air bladders to create a wave mixing
motion in the liquid

Bag support system

Relates to a rigid support housing for single use
bags formed by applying a vacuum to media
trapped in an intermediate chamber of the walls

Filter with memory, communication,
and pressure sensor

Relates to a radiofrequency-identification (RFID)
pressure sensor to determine integrity of individual
filters in a multi-filter device

Methods for purifying a target protein
from one or more impurities in a sample

Hamilton Brook Smith
Reynolds congratulates
EMD Millipore Corporation’s
J. Dana Hubbard on his
outstanding leadership as
head of patents.
We are privileged to
partner with Dana and the
EMD Millipore legal team

Relates to a method of purifying proteins such as
monoclonal antibodies

in protecting the company’s

Sampling system

advanced innovations, and

Uses RFID tags to identify the location and other
data relating to a sample being taken

we look forward to

Sampling system 2

continuing to protect and

Uses RFID tags to track a sample through the
laboratory taking and analysis system

defend EMD Millipore’s

intellectual property.

www.hbsr.com

AHLMAGAZINE.COM

science you have very black and white facts,” he says. “I
liked that. But with the law there are a lot more gray areas.
I struggled with that at first.” That struggle ultimately
led him to where he is today: working with eleven staff
attorneys across the globe. Hubbard is also one of about
sixty patent attorneys working for the various businesses
of Merck KGaA. He encourages anyone interested in the
law as well as science to consider a career in IP.
“The old joke was that an IP attorney was an engineer
who went to law school at night,” he says. “Now, it’s PhDs
from great schools who went to law school, and the characteristics of good IP lawyers include flexibility. Patent
law means every day you’re learning new things.” AHL

145

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≠≈>(%*
for
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≈%]-±<
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AHL APR.MAY.JUN 2017

PROGNOSIS

146

PROGNOSIS

DAVID BERRY
General Partner
Flagship Ventures

Flagship Ventures’ unique business model has created nearly thirty promising companies
working on medical and environmental technological breakthroughs
By Peter Fabris

U

thinking, a “crude characterization and a giant extrapolation of conclusions.” Even so, there was enough meat
on the bone to warrant further investigation.
This is how many of Flagship’s investments get
started: with a basic premise that the idea factory
investigates and turns into a marketable concept. The
process starts with a series of “explorations,” a term used
to describe how the firm examines the existing science
of a promising concept. During this stage, VentureLabs
researchers look at the concept dispassionately from an
outsider’s perspective and look at the topic from multiple
angles. With no one on the team banking on a future in a
narrow specialty, no Flagship personnel are beholden to
existing scientific orthodoxy. Therefore, the firm can ask
questions from unusual perspectives without preexisting
biases. “We have a willingness to be naive,” Berry says.
The first avenue of exploration of the human biome,
diagnostics to measure which bacteria were associated
with which diseases, didn’t pan out because no strong
correlations could be found. “We realized that we
couldn’t make good diagnostics, so we killed that one,”
Berry says. Another realization revolved around the

AHLMAGAZINE.COM

ntil recently, the human microbiome,
composed of the bacteria and other
organisms that live on and within us,
has been misunderstood and underappreciated by medical science. The past
decade or so has seen more interest in the field, as links
between the microscopic creatures living in our gut and
human health have been found.
It is a field that intrigues Flagship Ventures general
partner David Berry, as well as those working in the
firm’s “idea factory.” Flagship, a venture capital firm that
creates most of the companies in which it invests from
scratch, has a unique business model. The Cambridge,
Massachusetts, firm has a remarkable knack for spinning out promising start-ups focused on healthcare and
sustainability. Its systematic approach to research and
development is one that any enterprise could learn from
to foster a culture of innovation.
A few years ago, Berry and Flagship’s VentureLabs
unit, the idea factory, delved into research that suggested a link between certain gut bacteria and obesity.
The findings of the existing research were, to his

147

PROGNOSIS

PATENT PENDING
Flagship Ventures has spun off forty-five companies to date,
including these four.

Indigo Agriculture

Derived from research on microbiomes that led to the founding of
Seres Therapeutics, the company launched in 2013 and is focused
on the microbiomes of plants. Its mission is to develop plants that
can better withstand disease and drought.

Joule

Joule, which launched in 2007, has pioneered a platform that applies
engineered catalysts and photosynthesis to convert waste CO2 into
renewable fuels, such as ethanol or hydrocarbons used in diesel, jet
fuel, and gasoline. The company currently operates a small-scale
pilot plant and is exploring ways to rapidly scale up the process.

Moderna Therapeutics

Founded in 2010, Moderna is pioneering messenger RNA
therapeutics, a new in vivo drug technology that produces human
proteins, antibodies, and novel protein constructs inside patient
cells, which are in turn secreted or active intracellularly. This
breakthrough platform offers a superior alternative to existing drug
modalities for a wide range of disease conditions, the company says.

Evelo Biosciences

Founded in 2015, this company is dedicated to transforming cancer
therapy through a deep understanding of the cancer microbiome.
Evelo is discovering and developing novel treatments designed to
attack cancer by disrupting the microbial environment that supports
tumors and protects them from the body’s immune system.

premise that if the bacteria were impacting people, they
were probably secreting things. Most of this research
took place using mice, but the firm’s researchers found
that the microbiome of mice was much different than
that of humans, so that path turned out to be another
dead end.
Flagship didn’t give up on finding potential in the
human microbiome, though. It began to study the biology
of fecal transplants—where the microbiology of a healthy
person is transmitted to one with a disease, most typically those suffering from recurrent Clostridium difficile
infection. Such treatments were producing remarkable
recovery rates, Berry says. It wasn’t practical to turn
feces into drugs, but the research led to another realization: the gut microbiome actually functioned as a system
similar to an organ. Studies of 250 people with healthy
microbiomes showed consistent functionality despite
significant variations in the organisms.
This research led to the development of a proto-company—a kind of test project for a new company—and
then the founding of Seres Therapeutics in 2010, based
on what was known about the holistic functionality of
the microbiome. “We developed consortia at the core of
the microbiome’s function that allowed for other microorganisms to be attracted around them that would allow
for a shift in function from a disease state to a healthy
state,” Berry explains. Further, Flagship discovered a way
to isolate the active “ingredient” in fecal transplants and
thus had the basis for spinning
out Seres Therapeutics as its
own company.
In 2013, Seres began clinical
trials for a treatment for recurrent Clostridium difficile infection, which has been designated
as a breakthrough therapy by the
FDA. Seres’s approach also holds
promise for ulcerative colitis,
graft-versus-host disease, and a
range of other diseases.
Seres is just one of forty-five companies that originated in Flagship’s VentureLabs unit, and the list is
growing. “Every year, we produce about five companies
out of about ten proto-companies,” he says. One of the
keys to Flagship’s venture-generating process is having
no fear about canceling development of an idea or a prototype company when serious doubts are raised about
its viability. Even the exploration phase of an idea, a

AHL APR.MAY.JUN 2017

“Insurgent companies tend to
do well in areas where there
are no major players.”

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+-x
/±

x=

PROGNOSIS

GETTING STARTUPS

STARTED
Bring regulatory clarity.
disciplined process starting with a
research question, has a four- to six-week
deadline. If researchers can’t generate a
promising concept for a new company,
the exploration ceases or is redirected.
Too often in contrast, Berry says, leaders
of start-ups keep their organizations
afloat even when the business case for
the enterprise doesn’t hold up.
Flagship Ventures’ creations are
paradigm-shifters, companies developing
breakthrough technologies. They generally do not have to compete with large,
established players. “Insurgent companies tend to do well in areas where there
are no major players,” Berry notes. For
Flagship, when a proto-company doesn’t
appear likely to succeed, killing it off is
not considered a failure because it’s just
part of the creative process. And there
are always other promising ideas in the
VentureLabs pipeline to explore.
Another key to Flagship’s success is
that its researchers, unlike most others,
do not specialize in specific fields of
study. They do not depend on getting
published in scientific journals to boost
their professional prestige. This frees
them from asking oddball questions and
allows them to believe in ideas that many
experts might consider far-fetched. “We
can go in and out of fields as we like,”
Berry emphasizes.
The result is intellectual freedom that
is critical to Flagship’s business model.
There’s also a good chance that it will lead
to numerous medical breakthroughs. AHL

Actualize your game plan.

OUR STRENGTHS
BECOME YOURS.

hallorancg.com

AHLMAGAZINE.COM

Halloran Consulting Group is proud to partner with David Berry and Flagship Ventures to help small companies
act with the expertise and efficiency of larger organizations. Our strengths become yours, bringing decades of
industry knowledge in clinical and regulatory strategy,
investment due diligence, quality management systems,
and more. We understand that no two problems can be
solved with a cookie-cutter approach, so we lend you the
best people to actualize your goals and help bring your
product to market.

Gut-check investments.

149

PROGNOSIS

Born to
Boot Up
Adam Goldâ&#x20AC;&#x2122;s lifelong interest in
computers continues to pay dividends
as UC Irvine Health implements new
technology systems

AHL APR.MAY.JUN 2017

By Joe Dyton

150

PROGNOSIS

W

“Being able to say you’ve
been there and you’ve done
that really does help a lot in
this industry.”

ADAM GOLD
Director of
Infrastructure
Technology
UC Irvine Health

initiatives, user adoption, or just general support. Being
able to say you’ve been there and you’ve done that really
does help a lot in this industry.”
Credibility will be a key quality in Gold’s arsenal as
he’s helping UC Irvine Health’s conversion to the Epic
EMR system. UC Irvine Health had implemented the
Allscripts EMR system seven years previously, but leadership decided to make the switch. After a period of due
diligence, UC Irvine Health decided to partner with UC
San Diego Health via a community-connect model.
“On the San Diego side, they have been running Epic
for upwards of ten years now,” he says. “They are very
well-versed in Epic, and they’ve gone through upgrades.
Now, we’re going through this transformation, moving to
Epic, and collaborating with UC San Diego to not reinvent the wheel, but as an opportunity that if anything
needed to change within the environment, now is a good
time to do it.”
Going forward, the hope is that the implementation
of Epic at UC Irvine Health will help streamline processes. Between Irvine and San Diego campuses, there
are currently just fewer than 3,000 servers (physical and
virtual), and thousands of databases and applications
with different vendors that all have various requirements
of operating systems and network connectivity needs.
To combat this fragmentation, Gold believes UC
Irvine Health will end up going with a hybrid approach.
The organization will have a local presence at the Irvine
and San Diego data centers for the systems that require
it, and it will also have a second, virtual-hosted model
where the organization would shift its workloads to the
cloud and out of the data center.
“You’re looking at, basically, a multitiered approach
depending on the needs of the system and the needs of
the user, the requirements of the application, etc.,” he
says. “Our goal is to get out of the data center business.
There is a lot of overhead. It’s a lot of time and support
invested. With all the other initiatives we’re working on,
data centers are one thing we just do not want to have to
worry about.” AHL

AHLMAGAZINE.COM

hile his childhood classmates were
improving their athletic skills during
summer vacation, Adam Gold was at
computer camp. His interest in computers developed at an early age, and that
passion steered him toward his career path before
many of his peers.
“During the summer, I would basically sit in a trailer
and learn how to program on an Apple IIe in Logo, which
was kind of visual basic at the time,” Gold says. “My
parents were at a level where we weren’t rich, but were
able to afford a computer every few years. So, I had my
Timex Sinclair and IBM PCjr and really just got hooked.”
Gold’s decision to bypass sports camp and learn about
computers paid off for him in the long run. He is now the
director of infrastructure technology at University of
California (UC) Irvine Health and is the interim chief
technology officer of UC San Diego Health. He oversees
the technology side of the house: server infrastructure,
telecommunications, desktop engineering, storage, networks, and some out-of-the box development.
He started as a contractor at UC Irvine to work on the
university’s Y2K project, replacing and upgrading PCs
and installing new software. Then, he received a permanent position as an entry-level desktop technician
before he accepted the CIO's invitation to join him at
Micro General, where Gold picked up valuable exposure
to web-based programs like ASP and SQL.
“Because I was tinkering with it, I also got thrown into
this pseudo-server admin role, where I was being asked
to manage servers used for production and development
that were based out of Chicago,” Gold says.
A few years later, he had the opportunity to work with
First American Title in the command center, managing
and overseeing nearly 800 servers. This was during the
big escrow boom, which elevated the necessity of the
platform. Gold helped build this command center, and
that experience came in handy when he returned to UC
Irvine Health in 2003 to manage its server team.
Since then, Gold has also expanded his focus to client
services along with emerging technologies to implement
in the organization and hospital. His responsibilities for
the server and desktop teams, clients, and a variety of
other projects—combined with changes within the organization during the last few years—led to Gold eventually
overseeing the technology side of the house.
“The experience is invaluable,” Gold says. “There are
some leaders you work with where you can tell they’ve
never been in the role they are speaking to. For me, I
can confidently say I understand what it takes most of
the time when we’re talking about implementations,

151

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AHL APR.MAY.JUN 2017

PROGNOSIS

The Service Advantage
Reengineered specialty pharmacy BioPlus cuts
through the red tape for vulnerable patients and finds
cost savings for insurers
By Peter Fabris

R

leader in niche healthcare organizations for two decades,
and he says he is most proud of instituting policies and
processes that have made a real difference in the lives
of patients. This consistent execution of high-quality
service is the key to success, he says—particularly for
niche players in the healthcare industry. For BioPlus,
the cornerstone of its service model was laid out with a
complete reengineering of order and tracking processes
that included a year-long development of a proprietary
patient tracking system.
The impetus from this effort came from a meeting
between the company’s CEO, Stephen Vogt, and a nurse
with a healthcare provider. Vogt proudly pointed out to
the clinician that BioPlus initiated orders twice as fast
as its competitors. The nurse appreciated the observation, but countered that if patients were diagnosed with
cancer, they would want to have medication approved
and start treatment as soon as possible.
“The most important role for a specialty pharmacy is
connecting with the patient to quickly start them on the
right drug at the lowest cost,” Gay explains. “Research
shows that the quicker you start the patient on the

RUSSELL GAY
Chief Strategic
Officer
BioPlus Specialty
Pharmacy

AHLMAGAZINE.COM

eceiving news from a doctor that
you’ve been stricken with a debilitating disease—such as multiple sclerosis,
Crohn’s disease, cancer, HIV, or hepatitis C—is quite the shock. The last thing
you need afterward is a struggle to get medicine to treat
said condition. Unfortunately, that can be the case when
a physician prescribes a specialty drug. These medications are not available at a local pharmacy and cost substantially more than most other medicines. They may be
new to the market, and you might have to fight with your
insurance company to get one. Even if all goes smoothly,
it may take weeks to get your prescription filled.
That is, unless your specialty drug provider is BioPlus
Specialty Pharmacy.
BioPlus has been able to outperform its competition by
reducing the wait time to fill that first prescription to just
a few days. This devotion to customer service has helped
the twenty-year-old company grow at an enviable pace
in the past few years. Annual revenue has soared from
about $60 million in 2011 to about $850 million in 2015.
Russell Gay, BioPlus’s chief strategic officer, has been a

153

AHL APR.MAY.JUN 2017

PROGNOSIS

154

medication, the more likely they are to continue taking
it.” Patient compliance being of the utmost importance,
BioPlus took the nurse’s critique to heart and brainstormed on how to speed up its processes.
A top to bottom assessment of systems and processes
showed there were too many steps and too many people
with a hand in moving orders along. BioPlus set out to
streamline the steps and reduce the number of employees handling each case. The company also set an ambitious goal of contacting patients within two hours of
receiving a prescription. No software on the market
could accommodate this aim, so the company had to
develop its own platform.
Part of this challenge had to do with receiving orders.
BioPlus is not electronically linked to healthcare providers’ EMR systems. In fact, some physicians’ offices still
submit orders via fax. Complicating the matter further,
each insurer has its own form to process specialty drug
claims, some of which can be lengthy and complex. “All
the information has to go out correctly, or the claim will
be denied,” Gay says.
It took about a year for the company to develop a
system that could handle that level of complexity. A key
feature is the ability for managers to monitor the progress of individual orders in real time. BioPlus’s clinical
team watches electronic monitors that display progress
through a traffic signal scheme. Green indicates the order
is progressing on time, yellow means time is beginning
to run short, and red shows that the order is getting close
to missing that two-hour window to contact the patient.
That initial phone call informs the patient that the prior
authorization process is underway.
“We wanted a goal and a penalty to hold ourselves
accountable,” Gay says. If the company misses the twohour window, it then makes a contribution to a charity
such as the American Cancer Society or the Chronic
Disease Fund.

“It’s all about understanding
what you are good at. The real
magic is in the execution.”

The strategy has worked; BioPlus consistently meets
the time limit 98 percent of the time, with an average
response time of seventy minutes. “Some patients are
still driving home from their first doctor’s visit when we
contact them,” he says. While patients are still emotionally processing the diagnosis, the rapid response from
the pharmacy offers at least a small source of comfort,
with BioPlus providing assurance that someone is taking
charge of the complex pre-authorization process. It’s no
secret that patients can be intimidated by all the hoops
they need to jump through to receive their medication,
particularly in a vulnerable state after a diagnosis. “They
need someone to navigate the abyss,” Gay says.
In a sense, BioPlus’s primary customers are the insurance providers and, by extension, the employers who pay
the premiums. These players appreciate the company’s
stellar patient services, but they also want to see some
economic efficiencies. In fact, some don’t fully understand how specialty pharmacies provide value, Gay
explains. This is where the company’s electronic records
system provides an advantage. Using this system, BioPlus
analyzes the spectrum of data it has compiled about

PROGNOSIS

patients receiving treatment for specific
diseases and found ways to achieve
notable savings, Gay points out.
For example, the company found that
the cure rate for hepatitis C patients
who took medication for sixty days was
identical (98 percent) to those who took
medication for ninety days. Reducing the
amount of medication for these patients
from a ninety-day dose to a sixty-day dose
while still achieving the same outcome
created annual savings of $15 million in
2015, Gay says.
Further analysis of the company’s
patient data in specialized niches will
continue to show areas for savings, he
says. This is especially important in an era
where healthcare is increasingly focused
on using resources more efficiently,
according to patient outcomes. Indeed, by
continuing to provide best-in-class patient
service and finding savings for insurance
providers and their customers, BioPlus is
poised to continue its rapid growth as it
expands services in areas in specialties
such as oncology. “It’s all about understanding what you are good at,” he says.
“The real magic is in the execution.” AHL

work that BioPlus
Specialty Pharmacy
does to ensure optimal
patient care.
Robert Irene,
President

proven collaborative solutions
AHLMAGAZINE.COM

For more than a decade, Asembia has been working
with specialty pharmacies, manufacturers, prescribers,
payers, and other industry stakeholders to develop solutions for the high-touch specialty pharmaceutical service model. Through collaborative programs, contracting
initiatives, patient support hub services, and innovative
technology platforms, Asembia is committed to positively impacting the patient journey. For more information
visit www.asembia.com.

and the incredible

“

“

We applaud Russell

155

PROGNOSIS

On
Both
Sides
Now
Diane Duvall strengthens the ethics compliance
program at Catalent Pharma Solutions by leveraging
her cross-departmental expertise

AHL APR.MAY.JUN 2017

By Jeff Silver

156

PROGNOSIS

hile the role of a legal leader involves
regular interaction with many corporate functions, Diane Duvall has
developed a high-performance relationship with human resources at Catalent
Pharma Solutions. In fact, she even temporarily assumed
a dual role as both VP of human resources for corporate
functions and VP of legal, ethics, and compliance several
years ago. As a former law firm litigation partner, Duvall
represented various types of employers, including hospitals and pharmaceutical companies. She worked with
their HR functions before moving in-house at Sanofi
(formerly Aventis), where she supported its HR team
on employment-related investigations and litigation
matters. Now at Catalent, Duvall serves as a member of
the legal and HR leadership teams as the VP and deputy
general counsel, where she is providing oversight management to the ethical compliance program.

W

What makes the combination of human resources
and ethics compliance such an important and effective combination?
Diane Duvall: Companies with cultures that emphasize
integrity have more engaged employees and consistently
outperform those that do not. Both human resources and
compliance have a keen interest in ensuring that employees understand a company’s standards of behavior, corporate mission, and values. Those who understand and
embrace those elements succeed, while those who do not
are given appropriate feedback and, if needed, appropriate discipline.
Both human resources and compliance also serve as
common sources of advice for employees. That can be to
seek clarification or to express concerns, both of which
are key aspects to an effective compliance program. As
such, working together helps avoid duplication of efforts
and provides a better understanding of what’s working,
what’s not, where expectations might need to be clarified,
or where additional training may be needed.

Duvall: We do have some unique and complex regulations to comply with. But what’s critical is that our
employees are clear about the compliance obligations

that apply to their respective roles and that they understand why compliance matters. In practical terms, that
means ensuring that everyone in every department
understands how every decision and action we take
impacts our success in supplying more products and
better treatments to our customers and in creating a
culture of quality and compliance.
When it comes to our partnership, the US Sentencing
Commission’s guidelines for organizations and other
applicable regulatory compliance guidelines have
recognized human resources’ role in establishing
organizational cultures and in helping to prevent,
detect, and deter unethical conduct. Human resources,
more than any other function, regularly interacts with
employees, from recruitment and onboarding to ongoing
employee training and performance feedback—even
through to exit interviews at termination. All of these
activities provide opportunities to align our mission
and values with ethical leadership development and to
gain insight about where there may be opportunities
for improvement.

DIANE DUVALL
VP, Deputy
General Counsel
Catalent Pharma
Solutions

What advantages can you offer through your combined experience in legal, human resources, and
compliance fields?
Duvall: Because I have practical experience in all three
areas, I have a better understanding of the challenges
each one presents, and that helps me propose practical, realistic solutions. In my current role, I often
pull human resources and other corporate functional
subject-matter experts together to conduct investigations. My background helps ensure we stay on track to
meet legal requirements and determine what is right for
the company and for our corporate culture. For example,

AHLMAGAZINE.COM

Because the pharmaceutical industry is highly regulated, that interdepartmental relationship must be
an incredibly important one to maintain.

“Companies with cultures
that emphasize integrity have
more engaged employees and
consistently outperform those
that do not.”

157

PROGNOSIS

LEG UP.
When faced with the complex,
multi-jurisdictional legal
challenges that can arise today,
it’s helpful to know you have an
edge. Clients who work with
a law firm of our scale can tap
into extensive global resources
and connections – not to
mention lawyers in more than
30 countries who practice in
hundreds of areas of local and
international business law.
We salute Diane Duvall
for her myriad professional
accomplishments.

when we deal with bribery or harassment
allegations, we might find nothing illegal,
but discover there was a conflict of interest that should have been disclosed. Or
there might have been rude behavior that
occurred that violates our values and still
needs to be addressed.
My HR experience and work as a trial
attorney also helps me envision how things
might appear to a jury, who often care more
about what seems “fair” than the letter of the
law. And, quite honestly, my various experiences in these different areas also provide
me with good stories to share in compliance
training sessions.
Do you bring any unique perspectives to
your legal work as a result of your experience as an HR executive?
Duvall: Things that may seem like common
sense to an employment or compliance
counsel may still be foreign to an employee
in another function. Until you sit in the other
person’s seat, it’s easy to forget that giving
advice is often easier than taking it or actually acting on it. So having been on both sides,
I hope I have learned to be more patient
and understanding.
Are you involved in any specific initiatives
related to protecting or developing the
corporate culture?

AHL APR.MAY.JUN 2017

www.dlapiper.com

158

John R. Wellschlager, The Marbury Building, 6225
Smith Avenue, Baltimore, MD 21209 | DLA Piper LLP
(US) is part of DLA Piper, a global law firm, operating
through various separate and distinct legal entities.
Further details of these entities can be found at
www.dlapiper.com. | Attorney Advertising

Duvall: We’re working on reinforcing our
speak-up culture. We want to create an
environment where people feel comfortable
coming forward with questions or concerns,
particularly when it comes to safety and the
well-being of those who rely on the products and services we provide. We are always
looking for new ways to engage employees
that help avoid compliance fatigue that often
comes with all the different rules, regulations, and responsibilities that apply to our
business. And, finally, we are formalizing our
patient-first culture, which will raise awareness about the impact that all of our business
decisions and actions can have on patients
using our products. AHL

PROGNOSIS

Healthcare
In Her Blood
Bhavi Shah began as a litigator, but found her calling as a healthcare
attorney. She now uses that passion to help Blood Systems, Inc. succeed
within the evolving transfusion industry.

Over the last several years, US healthcare has been experiencing what may
be the greatest restructuring and reorganization since the implementation
of Medicare and Medicaid in the 1960s.
It impacts every level and type of care, including companies in the transfusion medicine industry, which already
faces unique issues that make successfully navigating the
ongoing evolution even more challenging.
This is true even for large companies such as Blood
Systems, Inc., a nonprofit organization based in Scottsdale, Arizona, that delivers blood products in twenty-four
states and provides about 12 percent of the country’s
blood supply. It also distributes specialty plasma-derived
pharmaceutical products in forty-eight states through
its BioCARE operations and, through its joint venture,
Creative Testing Solutions, tests roughly 35 percent of
the country’s blood supply.
Similar to other sectors of healthcare, blood service
providers deal with the ramifications of reduced reimbursement and customers’ increased focus on cost of
services. But there is also pressure to shift away from its

BHAVI SHAH
Executive VP,
General Counsel
Blood Systems,
Inc.

AHLMAGAZINE.COM

Michael Paulson

By Jeff Silver

159

PROGNOSIS

160

traditional local community focus to meet the requirements of hospitals that are joining systems that cover
larger geographic areas. At the same time, the overall
blood donor base has eroded as baby boomers age and
travel restrictions prevent donations from individuals
returning from areas where diseases such as the Zika
virus and mad cow disease are present.
According to Bhavi Shah, Blood Systems’ executive VP
and general counsel, these circumstances compound the
differences in legal and regulatory compliance issues that
blood service providers face compared to other healthcare organizations. “Blood products are different from
pharmaceuticals or medical devices, and there isn’t a lot
of established case law. So, we work closely with federal
regulators and constantly review applicable law and
regulations to figure out how they apply to our industry,”
Shah explains.
Blood Systems has addressed the shrinking donor
population and changing demands of clinical customers through a combination of improved operations and a
focus on mergers and acquisitions to help bolster capacity, its geographic footprint, and economies of scale. Its
Supply Chain Optimization for Performance Excellence
(SCOPE) program, for example, has helped streamline
ongoing business activities. Donations collected at nearly
one hundred locations are processed and manufactured
at centralized facilities, and final products are returned
to individual centers for local delivery. This approach
optimizes production, maximizes capacity, and enables
Blood Systems to meet the needs of large regional and
national healthcare delivery networks.

Blood Systems operates community blood centers that
serve more than 700 hospitals in twenty-four states.

Mergers and acquisitions activity also helps broaden
company bandwidth, but produces additional challenges
for Shah and her legal department. In 2014, when Shah
joined the company as a department of one, she closed
two new affiliations, one joint venture, and one asset
purchase. At the start of the third quarter of 2016, Blood
Systems had closed three mergers and had four more
transactions scheduled by year-end. Annual revenue was
projected to be about $1.1 billion, a 35 percent increase
since Shah joined the company. Her team has also grown
to include a second attorney and a paralegal.
With each transaction—such as a stool bank (fecal
microbiota transplant for the treatment of C. diff), source
plasma, and an umbilical cord storage program—Shah is
responsible for assimilating new lines of business and
their corresponding compliance requirements. But she
also has to maintain system and administrative consistency. “Along with the level of activity that goes with
mergers and acquisitions, the legal department also has
to integrate systems and update and create templates
that can be used across all our different business units,”
she points out.

Michael Paulson

AHL APR.MAY.JUN 2017

“Blood products are different
from pharmaceuticals or
medical devices, and there isn’t
a lot of established case law. So,
we work closely with federal
regulators and constantly
review applicable law and
regulations to figure out how
they apply to our industry.”

PROGNOSIS

Shah began her career as a litigator, focusing on pharmaceutical and medical device product liability and medical
malpractice. However, she was interested in becoming
more of a corporate generalist. Shah took a position with
Cold Stone Creamery, which was acquired by Kahala
Corp. This move gave her experience with a national
food franchisor, an interesting new challenge. However,
she discovered that she missed healthcare and eventually
moved to become assistant general counsel at Phoenix
Children’s Hospital.
Before being considered for her current position, Shah
had been unaware of Blood Systems' extensive range of
products and services, even though the company was a
local community provider to Phoenix Children’s Hospital. “I discovered that I could bring my litigation and
corporate experience to the company’s focus on diversification and expansion. And the opportunity allowed
me to stay in nonprofit healthcare and be part of a
mission-driven organization,” Shah recalls.
As she assesses the challenges that lie ahead, Shah
says the company will have to decide whether to preserve
local community brands (some of which have existed for
seventy-five years), cobrand, or rebrand nationally. It will
also need to focus on recruiting the next generation of
blood donors and building internal legal and governance
infrastructures to keep pace with company growth.
Shah sees herself as looking out for Blood Systems’
best interests in every domain. “I’m the eyes and ears of
the organization when we’re assessing new opportunities, accomplishing strategic business objectives, and
mitigating risks,” she says.
Shah notes that she did not have extensive M&A or
governance experience when she joined the company.
However, her network of outside resources and trusted
mentors enabled her to develop essential expertise in
these areas and to become a highly effective “protector”
and problem-solver in the midst of the always changing
healthcare landscape. AHL

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161
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10/7/16 5:20 PM

PROGNOSIS

The New Face of
Analytics
New generations of technologies have made informatics professionals integral players in
Horizon Blue Cross Blue Shield’s business strategies

AHL APR.MAY.JUN 2017

By Jeff Silver

162

With more than twenty years of experience in analytics and informatics,
Jason Cooper, VP and chief analytics
officer at Horizon Blue Cross Blue Shield
of New Jersey, has been part of an evolution that has exponentially changed how analytics is
implemented in numerous industries. Perhaps none is
more significant than its role in the transformation of
US healthcare and health insurance from fee-for-service
to fee-for-value.
Cooper points out that the maturation of technology
has fueled the recognition of data and analytics as both
strategic assets and competitive differentiators. This
has dramatically shifted the role of technologists in the
workplace. “Beyond programming, math, and statistics,
we now have to more deeply understand the business
verticals we serve,” Cooper says. “If we work on clinical analytics, for example, we have to understand that
language and be able to probe deeper to ask the right
questions to put the underlying nuances, objectives, or
business context into sharper focus.”
To accomplish this, his team has to focus on improving business acumen and relationship management,
as well as acting as consultants. This places “analytics
geeks” (a term Cooper uses with pride and affection)
in new territory. As a result, they have learned how to
prioritize analytics projects so that the most important
information is summarized and placed in a longitudinal

business context with other key performance indicators
and benchmarks.
“Providing a spreadsheet with 300 different numbers
is confusing. It’s important to present concise insights
that can be understood quickly to help business leaders
make fast, informed decisions,” Cooper explains.
The new role can also involve what Cooper refers to
as “challenging conversations” to clarify which of many
potential projects internal customers need to prioritize
in order to produce the most value. “It can be difficult for
business leaders to realize that we can only deliver on a
portion of what they’re asking for, but it leads to higher
value and very collaborative exchanges,” he says.
As roles change, Cooper also sees that chief analytics
and chief data officers need to be able to provide guidance on topics that are often considered to be outside
their core areas of expertise. They must translate critical
information among the worlds of data assets, IT, analytics, and business utility.
A prime example is Horizon’s OMNIA Health Alliance. The statewide partnership of five large, integrated
delivery systems and a large multispecialty group provides a fee-for-value environment to many of Horizon’s
members. The platform is supported by new bidirectional data-sharing capabilities, decision support
systems via advanced visualizations, and high availability for disaster recovery and business continuity with an
ever-present focus on privacy and security.

“The more information we
have about a member’s
circumstances, the better able
we are to connect them to the
care and services they need.”

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AHLMAGAZINE.COM

A key differentiator is clinically intuitive knowledge
gained through the exchange of information between
EHRs and certain administrative claims data. To facilitate these components, Horizon’s IT group and Cooper’s
teams had to dive into data latency, the cloud platform,
and providers’ workflows to optimize insights that
improve care quality, lower overall costs, and improve
the member experience. “We had to understand facets on
the technical, clinical, and administrative sides in order
to identify the right analytics protocols and support tools
needed to serve the operational and clinical needs of all
stakeholders,” he explains.
Initiatives like OMNIA will continue to make Cooper’s
job and the responsibilities of the analytics department
more complex. Previously, analytics data, such as drug
and diagnosis codes, was typically highly structured. But
new technical capabilities enable the analysis of unstructured data, such as clinical case notes or recorded customer service calls.
Cooper explains that these new technical capabilities
and the ability to further integrate data have opened tremendous new possibilities for advancing healthcare. For
example, having an address and knowing that a member
has transportation challenges can help coordination
with his or her healthcare professional or community
resources to increase access to care. “The more information we have about a member’s circumstances, the better
able we are to connect them to the care and services they
need,” he says.
As the templates for care delivery and reimbursement
evolve, so too has Horizon’s business model. Its technology teams have been heavily involved in the redesign of
the company’s website, mobile app, and other digital
assets to be more consumer-driven. “We’re thinking
less like an insurer and more like a consumer-centered
company,” Cooper says. “That means letting customers
drive the interactions and needing to connect with them
in different ways and on different platforms.”
As analytics continues to transition into fulfilling its
new and much more strategic role, Cooper predicts that
it will shed its reputation as a cost center. “If you spend
millions on analytics, you should be able to show three,
five, or even seven times that amount coming back annually to the organization and its stakeholders,” he says.
“That’s just table stakes. Analytics is evolving into being
a value center.” AHL

163

PROGNOSIS

From Reactive
Healthcare to

AHL APR.MAY.JUN 2017

JEFF TERRILL
President
EXOS

164

PROGNOSIS

Proactive Health
Jeff Terrill knows from personal experience that his company can make employees healthier,
and he has the numbers to show it saves his clients money, too
By Russ Klettke

E

movement, an essential for improving performance that
focuses on moving your body better; and recovery, which
allows the mind and body to re-energize and prepare for
the next day’s demands.
By design, each of the four pillars is integral and
essential to the others. Terrill explains how mindset, for
example, is fundamentally important because it drills
down to individuals’ core motivations. “This is where we
break ambivalence, where we get to what their ‘it’ is,” he
says. “For example, a participant might say, ‘My back
pain is so bad I can’t play with my kids.’” When an EXOS
coach helps that person to develop a stronger, pain-free
body, the individual is inclined to stay in the program to
achieve other goals as well.
EXOS currently services 150 companies, which
includes 25 percent of the Fortune 100. A comprehensive institutional review board clinical study of the EXOS
program at one of those Fortune 100 companies found
that they achieved superior health outcomes compared
to a wellness study group. An independent actuarial
study at Cancer Treatment Centers of America found
that for every dollar spent, a return on investment
of $2.96 was achieved in lower healthcare costs and
lower absenteeism.
Terrill’s journey to lead EXOS—itself a division of a
broader enterprise that provides similarly structured
performance solutions to student and professional athletes and elite military—started from the other side of
health, that of a reactive mode. He formerly served in
executive roles responsible for health plans, managed
care operations, medical groups, and health insurance,

AHLMAGAZINE.COM

mployers are increasingly embracing
the benefits of healthy workplaces
with some version of company-sponsored wellness programs. But there
have also been mixed reviews on whether
these programs yield a financial return to the businesses
that sponsor them. The RAND Corporation published a
study in 2013 that found many programs in the $6-billion
workplace wellness industry do not yield a convincing
return on investment.
However, even a single healthier employee might be
considered a victory. At least one company can objectively claim success in providing proactive health solutions that have a positive return on investment: EXOS.
“The elegance is in the simplicity,” Jeff Terrill, EXOS
president, says. “Seventy-five percent of all chronic
disease is caused by four factors: food choices and
portion size, physical inactivity, stress, and tobacco use.
These factors are also responsible for 81 percent of all
hospital admissions, and these factors are controllable.”
EXOS’s proprietary methodology provides pathways
to improved health and performance that are broadly
applicable to the full employee population. Based in
solid science, the company’s methodology achieves a
high level of participation—including for the employees
who need it most.
The company’s methodology includes what they call
the four pillars of human performance: mindset, or dedicating oneself toward a goal with a full understanding
of what it requires to accomplish it; nutrition, or the
foundational support to fuel mind and body performance;

165

PROGNOSIS

“We provide companies with
flexibility to calibrate our
performance solutions across a
continuum of location types.”

EXOS is the proven leader in
proactive health and performance,
trusted by elite athletes, the
military, community centers,
colleges and universities, and
innovative companies worldwide.
We provide the knowledge and
skills people need to identify and
overcome obstacles, creating
personal breakthroughs. That's
why leaders around the world are
employing our individualized game
plans to transform their workforce
and help them live healthier,

AHL APR.MAY.JUN 2017

happier, and more productive lives.

166

To learn more about who we are, what
we do, and our industry expertise, visit
teamexos.com.

including industry leaders such as Cigna and Aetna. In
these positions, he was dealing with the disease side
of healthcare, helping people live with illness—a stark
contrast to proactive health, which focuses on disease
avoidance or elimination.
“When the recruiter called me for this position, I
initially thought it was an odd fit, because I thought
EXOS served only elite performers,” Terrill says. “But
I appreciated EXOS’s different approach and learned
how diverse the served population was.” Terrill reflects
on how, in the thirty years prior to this position, he witnessed the prevalence of disease explode. For example,
the rate of diabetes increased from one in fifty people to
one in ten, and obesity rose from 10 percent of the US
population to what now approaches about 40 percent.
“I asked, ‘What’s wrong with our healthcare system?’”
he recalls. He experienced, in granular detail, the costs
of taking care of diseases. Proactive health, he notes, is
far more effective and less expensive.
“EXOS had the answers,” Terrill says. So he took
the position and went to work. Being physically active
himself and an avid runner in relatively good shape, he
was surprised to find through the company’s assessment
measurements that his performance was suboptimal,
that he needed to hydrate more, get better sleep, work
on strength training, and train for movement quality.
The changes are palpable, he says, “a testimony of my
own performance improvement as a result of behavior upgrades,” as he describes it. His personal benefits
include eliminating knee pain and optimized biometrics,
which all occurred without prescriptions. “Food and
fitness are medicine,” he says.
The changing nature of work and workplaces requires
EXOS to evolve and adapt with them. “This means we
provide companies with flexibility to calibrate our
performance solutions across a continuum of location
types,” he says. For example, a gym isn’t necessary for
the program to work, as many off-site work locations are
too small to justify the costs of an on-site fitness facility. EXOS can utilize spaces such as conference rooms
to draw in participants who might be intimidated by
weights, machines, and mirrors for “no sweat” movement
sessions. EXOS’s digital technology capabilities allow its
programming to reach an employer’s entire population,
even those who work at home.
Proof is there that there are as many ways to become
healthy as there are to get sick. For Terrill, who has
worked on both sides of the equation, proactive health
is more than obvious. AHL

PROGNOSIS

The Conductor’s
Mentality

Bob Hudson has needed to make some tough calls at the Henry Mayo Newhall Hospital, but it’s his
ability to assess the greatest needs that has made the clinic a prominent healthcare destination
By Michael Hernandez

William Innes

A

When Hudson came to Henry Mayo, the hospital certainly had its share of problems. Chief among them, the
Santa Clarita Valley’s only hospital had felt the effects of
a 1994 earthquake for years, taking on millions in debt to
cover the repairs. By 2000, the hospital was reported to
be more than $38 million in debt. After joining the hospital in 2001, Hudson took the hospital into bankruptcy a
year later. It eventually emerged in 2003 with a four-year
reorganization plan and agreement to completely pay all
of its creditors.
So how did a hospital so deep in debt manage not only
to stay open, but dramatically increase capacity and even
open a brand new health and fitness center? As Hudson
learned, the key is learning to grow in a controlled
manner. Sometimes, this means saying no to certain
kinds of growth in order to focus on others.
“It’s hard. Sometimes you say no because it’s just
not the right time or financially it doesn’t make sense,”
Hudson explains. “A certain type of service may need
to be at a tertiary level facility or a specialty hospital
because we’d never have enough volume to be able to
keep the skill sets of our nurses, therapists, technicians,
and doctors. So, even though everyone wants it, you have

BOB HUDSON
Senior VP, CFO
Henry Mayo
Newhall Hospital

AHLMAGAZINE.COM

s the CFO of Henry Mayo Newhall
Hospital, Bob Hudson is spearheading
a major expansion of services available to the Santa Clarita Valley community in California. Already home to
an advanced primary stroke center, a vital community
cancer program, and an acclaimed breast imaging center,
Henry Mayo is constructing a six-story patient tower
that will expand capacity by 140 beds.
But an expansion such as this doesn’t happen overnight. Hudson is overseeing the financing of the project
as the completion of a fifteen-year master plan that’s
been in the works since he joined Henry Mayo in 2001. In
the years prior, though, Hudson gained some surprising
experiences that proved useful for hospital expansion in
ways one wouldn’t expect.
For instance, Hudson, as a CFO, once had to shut down
two hospitals out of a group of three in order to build up
the remaining hospital. “The business wind-down was
quite an experience,” Hudson says. “I think having gone
through that helped prepare me for this turnaround I was
able to participate in here because I saw some of their
problems. I hope I was able to avoid some of those.”

167

PROGNOSIS

“As I was lying in the cath lab
having an angioplasty, I was
talking to the staff and the
doctors, and I thought, ‘You
know, I’m awfully glad I helped
build this place.’”

POWERING
FINANCIAL
AND PATIENT
HEALTH

AHL APR.MAY.JUN 2017

takes a trusted
partnership

168

JACOBUSCONSULTING.COM

to say no because it’s not the right thing to do for the
community.”
Hudson hasn’t just been on the hospital administrator’s side of this kind of situation. He once attempted
to start his own business, researching and developing
alternative therapies for chronically ill patients. Hudson
and his business partner aimed to simultaneously reduce
chronic pain, reduce the cost of chronic illness, and
improve patients’ quality of life. Although pain control,
meditation, and journaling have since become common
in palliative care, Hudson found that his efforts were
about thirty years early. While the experience was educational, the answer at that time had to be no. But his
most important job, Hudson says, is trying to figure out
a way to say yes to difficult, yet important factors.
The Henry Mayo CFO can point to a long list of items
he’s been able to say yes to in his time at the hospital,
including a neonatal intensive care unit, open heart
surgery, a cardiac catheterization laboratory, and significant expansions to the hospital’s emergency room,
operating rooms, and intensive care unit. The clinic even
opened a nationally recognized breast imaging, surgery,
and treatment center.
However, even after one manages to say yes, there
are still stressors and obstacles before accomplishing
growth. There are financials, external relations, audit
committees, and frequently changing Medicare and

PROGNOSIS

state healthcare regulations to keep up with, for example.
Compliance presents a major task, but Hudson finds that
keeping up is a matter of hiring, educating, supporting,
and leading his employees.
His main advice to people who want to lead is to not
micromanage employees. “Often, the boss syndrome
wants people to be the boss. I’m more of a conductor,” he
says. “I don’t like to boss anybody. You hire good people,
give them opportunity, and let them do their job.”
While the challenges of the job can take a toll, Hudson
has found the results of his work worthwhile. He aims
to have the new patient tower completed by 2019 and
is working on increasing the hospital’s bond rating.
Keeping up with regulation, while a challenge, has certainly paid off, as Hudson has experienced it firsthand.
After a minor stress-related heart attack, he found
himself being treated at Henry Mayo.
“As I was lying in the cath lab having an angioplasty,
I was talking to the staff and the doctors, and I thought,
‘You know, I’m awfully glad I helped build this place, ’”
he says. AHL

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169

PROGNOSIS

The Results Are In
Harvey Guindi and Health Network Laboratories leverage IT to drive
efficiency and become more consumer facing

AHL APR.MAY.JUN 2017

By David Baez

170

Wisdom has it that at least threequarters of all healthcare decisions
are driven by data that comes from
testing laboratories such as Pennsylvania-based Health Network Laboratories
(HNL). Harvey Guindi, chief of information systems
(IS) for HNL, believes that improvements in the laboratory testing process similar to the ones his company is
implementing can have an impact far beyond the laboratories’ bottom line and in the world of healthcare at large.
Guindi also believes that IS has been put in a position to
have a central role in these initiatives. “As we’re moving
in the industry from focusing on results to focusing on
answers, information systems can help with dealing with
risk,” he says. “If you can get someone to deal with their
problem sooner rather than later and not end up in an
emergency room, that is going to benefit the system.”
Guindi positions IS as a leader in the company’s evolution. The department touches everything from medical
devices to revenue delivery and collections. Guindi is
in fact a member of the executive team, granted equal
importance and say in company decisions just the same
as finance, sales, or lab operations. “The importance of
intelligent leadership by the CEO in creating the environment that embraces innovation and evolution allows
each executive team member to contribute beyond their
core responsibility, benefit our organization, and our customers,” he says. “The thing about our executive team

is that while we each have our own domain, we’re all
charged with the growth and strategy of the company,
not just the effective management of our own area.”
The latest example of IS playing a key role in growth
and innovation at HNL has been the initiative to reduce
customer wait times at the laboratories’ fifty-plus
patient service centers. The executive team agreed on
a goal of maintaining its fifteen-minute-or-less patient
waiting time, an industry-leading standard, in the face
of increasing demand, patient volumes, and growing
network of patient access points. Once it was in place,
Guindi pushed to use tech to leverage the advancement,
promotions, and advertisements. Soon on the company’s
website, customers will be able to see average wait times
at any patient service center location. If they were basically equidistant between two locations, customers could
select a destination based on the shortest wait.
“That was an area of debate and conversation,” Guindi
recalls. “Maybe somebody could have to wait longer than
they expected, so there was a lot of discussion about what
it meant to provide this level of transparency, what the
pros and cons were. That’s the kind of engagement we
have; the willingness to challenge each other in terms
of what we can do and what we should do to create the
greatest value for our customers.”
When Guindi came on board in 2013, he put together
a bold, three-year strategy that is now in its final year.
There were four aspects: increase access to and for

patients, grow and retain existing business, improve
bad debt and revenue cycle management, and increase
operational efficiencies.
In terms of improving consumer access, Guindi says
he looked at it from a retail perspective, with a goal of
making the company’s service available when and where
customers wanted it. This meant extending hours, swapping appointments for walk-ins, and meeting the fifteenminutes-or-less goal. “We did this knowing that it drives
greater loyalty and more volume when people get their
needs taken care of,” he says.
The second initiative—to grow and retain existing
business—centralized on integration of systems. What
used to be done on paper moved to electronic interfaces, and Guindi’s team made sure that providers didn’t
have to jump through many hoops when dealing with
the company. A group was dedicated to improve EMR
systems integration with the laboratories themselves.
When Guindi came to the industry, he was taken back
by the notion that providers were expected to do the
highest quality of work with the greatest integrity, but
didn’t always get paid for it. Revenue cycle management
at HNL needed an overhaul. “It was a formula that was
going to bury us,” he says. “I said, ‘We have to look at this
from more of a retail perspective and put solutions in
place that improve our collections and ensure that the
reimbursement model doesn’t hurt us.’”
IS also used software to build more efficiency into the
collections system and saved an abundance of administrative overhead that had been eating at the company’s
profit margin—the fourth aspect of the three-year strategy. As the plan reached its conclusion in 2016, Guindi
says that the biggest challenge to healthcare providers
right now is still how to handle the industry’s shifting
of risk. “Whereas all these things used to be managed
by insurance companies, they’ve gotten out of the risk
model but are still the payers. Now hospitals, physicians,
and labs have to manage that risk,” he says. “The biggest
issue I see we’re faced with is how an industry not wellversed in managing risk now deals with that.”
It’s a challenge, but as Guindi has proved at HNL, IS
can play a key role in overcoming it. AHL

Health Information
Systems

HL
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Exc Info
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Ma hang matio
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“The biggest issue I see we’re faced
with is how does an industry not
well-versed in managing risk now
deal with that.”

Payers

171

PROGNOSIS

Cyber Solutions for
the Long Term
Long-term care organizations are employing increasing degrees of technology to improve
seniors' lives. Paul Nigro shares how that’s being implemented at Brookdale Senior Living.

AHL APR.MAY.JUN 2017

By Russ Klettke

172

Americans and most populations of
the developed world are aging, with
post-World War II boomers leading the
way into retirement and managing the
issues related to aging that eventually
come. The long-term care (LTC) industry—independent
living, assisted living, memory care, skilled nursing, and
other services—is already serving more than 13 million
people in the United States. And that number is projected to double by 2050, a year when 20 percent of the
country will be over the age of 65, according to the Stanford Center on Longevity.
The resources needed to serve this huge need will
be great. The companies involved in LTC are devising
several means of doing this, such as aging-in-place
services (home care) and building more facilities for
assisted living and memory care communities. They are
also finding that technologies offer exciting possibilities
to enrich the lives of residents and improve caregiving.
For example, look no further than Brookdale Senior
Living, Inc., a leading provider that operates more than
1,100 senior living communities in forty-seven states.
The company is an innovator and early adopter, due
in part to its growth through a number of mergers and
acquisitions during the last decade.
Its growth-by-acquisition strategy has been challenging in an IT capacity, as the communities it has
purchased have legacy systems and data that need to
be kept intact to satisfy regulators. “We look at their
excellence,” Paul Nigro, senior VP of integration for the
company, explains. He refers to the characteristics of
quality enterprises that made them attractive acquisitions in the first place. “With single location facilities, we
can bring them into our system within twenty-four hours
of the closing and train their staff on operational use in
under thirty days,” he adds. Multilocation acquisitions,
he notes, take longer.
The investment in wireless technologies in communities serves an important purpose. Nurses and other caregivers now keep records on tablets, replacing what was
formerly done on paper charts. Nigro details how indi-

PAUL NIGRO
Senior VP
Brookdale Senior
Living

vidual patient care plans and medication schedules are
on a single platform, which improves staff efficiency and
caregiving itself. Devices are attached to carts, making
the digital tool an intrinsic part of daily nursing tasks.
But the digitization of the operation of Brookdale communities fosters something else, Nigro says. “We work to
disconnect administrators and other leaders from their
desks to get them into the community, engaging with our
residents and families,” he says. “Not only do these tools
ease the workflow, but the less time they spend in front
of a screen means more time touching lives.”
Another workflow benefit is where Brookdale employs
technologies in the home health services portion of their
business. Where mobile caregivers formerly needed to
physically access files for patients, electronic delivery
and applications on mobile devices have revolutionized
that process and made it more efficient.

PROGNOSIS

“It’s a much more efficient documentation process in
home health services,” Nigro says. “The caregiver can
take notes and electronically share information with the
next caregiver. That reduces a lot of time spent retrieving
paper notes.”
Efficiencies and improved caregiving quality are just
two benefits of the increased use of technology in longterm care environments. According to a 2014 article in
healthcare technology publication HITConsultant.net,
automation can reduce labor, reduce human error and
fatigue, reduce paper waste, provide greater predictability in patient outcomes, identify when patients fail
to adhere to a therapeutic schedule, and deliver datadriven insights on program efficacy and improvements.
Nigro notes that technology has a growing role in
helping the company achieve its mission of enriching lives. “Over the past several years, we’ve invested
heavily in the technology necessary to provide wireless
communications to our residents,” he says. “This promotes resident and family engagement through iPads
and smartphones. They can connect via FaceTime.”

“We work to disconnect
administrators and other
leaders from their desks to get
them into the community.”
Such connectivity, more typically associated with the
grandchildren of most LTC residents, makes sense from
a clinical health standpoint. According to a “Rewiring
Aging” study that Brookdale conducted (guided by the
Stanford Center on Longevity), a third of respondents
would like to be able to text or video chat with family
and friends, more than a quarter would be interested
in taking group classes to learn how, and only 5 percent
say they are completely opposed to new technology. And,
more to the point, those that did start connecting with
others through technology showed powerful emotional
benefits. “Connectivity, particularly between distant
family members and our residents, is a big part of the
future,” Nigro says. “What runs through everything is
finding the best ways to serve our seniors.” AHL

AHLMAGAZINE.COM

Comview is proud to provide Brookdale Senior Living with substantial savings, productivity increases, and control over fixed and mobile telecommunications expenses, inventory, and related processes since 2012. Comview
simplifies enterprise telecom management throughout the communications lifecycle—from procurement to bill payment and points in between­—
so staff can focus on higher-value activities while gaining transparency
and sustainable ROI. Comview offers a flexible, customized, cloud-based
platform and friendly expert managed services with savings guarantees.
www.comviewcorp.com

173

PEOPLE INDEX

The Vitals
NADEEM BRIDI, P. 29
Chief Intellectual Property Counsel
Acelity L.P. Inc.
With more than fifteen years of experience
licensing and acquisition of intellectual property
rights, Nadeem Bridi has been at Acelity since 2001.
LAWRENCE IRENE, P. 114
CEO
Asembia
Holding a degree in pharmacy from St. John’s
University School of Pharmacy, Lawrence
Irene has twenty-five years of experience in
healthcare and has helped found multiple
successful companies, including Asembia.
MARIAM KOOHDARY, P. 120
Deputy General Counsel
AstraZeneca
Since 2005, Mariam Koohdary has been a part
of the AstraZeneca team. Today, she serves on
the pharmaceutical company’s US Leadership
Team and the Legal Senior Management Team.
RUSSELL GAY, P. 153
Chief Strategic Officer
BioPlus Specialty Pharmacy
Russell Gay helps develop plans for one of the
leading specialty pharmacies in the United
States, BioPlus. He also founded his own
consulting firm and is the executive director for
the Independent Specialty Pharmacy Coalition,
an industry advocacy organization.
BHAVI SHAH, P. 159
Executive VP & General Counsel
Blood Systems, Inc.
Aside from overseeing all aspects of legal
compliance and counsel for Blood Systems,
Inc., Bhavi Shah belongs to American Health
Lawyers Association, the Association of
Corporate Counsel, and the Arizona Association
of Corporate Counsel.
PAUL NIGRO, P. 172
Senior VP of Integration
Brookdale Senior Living

AHL APR.MAY.JUN 2017

Paul Nigro is a certified public accountant and
holds a bachelor’s degree in accountancy
from the University of Illinois at UrbanaChampaign. He’s been with Brookdale Senior
Living since 1997.

174

RANDY SERGENT, P. 101
VP, Deputy General Counsel, & Assistant
Secretary
CareFirst BlueCross BlueShield
Randy Sergent’s legal expertise isn’t confined
just to CareFirst’s Baltimore office. He serves as
a commissioner on the Maryland Health Care
Commission, which is responsible for issuing
certificates of need for hospitals and other

institutions and addressing other state health
policy issues. He has served as the chair of the
Maryland State Bar Association’s Health Law
Section, and next year will serve as chair of
the Maryland State Bar Association’s Standing
Ethics Committee. He is also a member of the
Board of the Howard County Conservancy, a
local land trust and nature center that provides
nature education to school children in Howard
County Maryland.
DIANE DUVALL, P. 156
VP, Deputy General Counsel
Catalent Pharma Solutions
With a degree from Rutgers Law School, Diane
Duvall has served as an in-house counsel in
the pharmaceuticals industry for more than
fifteen years.
BILL FEASTER, P. 106
Chief Medical Information Officer
Children’s Hospital of Orange County
Specializing in pediatrics and anesthesiology,
Bill Feaster earned his MD from the University
of Rochester School of Medicine. He currently
belongs to the American Academy of Pediatrics,
California Society of Anesthesiologists, and
Lasallian Education Fund.
TETYANA BUESCHER, P. 63
General Counsel
CompuGroup Medical
In addition to her role as CompuGroup’s
general counsel, Tetyana Buescher is trilingual
and she is on the marketing committee for
the General Counsel Institute at National
Association of Women Lawyers and a mediator
at Association of Corporate Counsel.
SONIA CHEN ARNOLD, P. 42
Assistant General Counsel for Litigation & Legal
Compliance
Eli Lilly
Sonia Chen Arnold has won a host of accolades
including being recognized as a Rising Star by
Indiana Super Lawyers in 2009, 2010 and 2011;
being selected to participate in Class XXXIII of
the SKL Leadership Series; being a finalist for
Young Professionals of Central Indiana’s Young
Professional of the Year Award in 2008; and
serving as the Taiwanese American Heritage
Week Master of Ceremonies in 2006.

DAVID PETERSON, P. 66
CIO
Erlanger Health System
After more than a decade with the navy, where
he cut his IT teeth, David Peterson ran a gamut
of jobs that would ultimately prepare him for
his role with Erlanger, including the University
of Maryland Medical System, Catholic Health
Initiatives, Boston Medical Center, and
Dimensions Health System.
JEFF TERRILL, P. 164
President
EXOS
Jeff Terrill has been in healthcare for more
than twenty years. Before assuming the role of
president at EXOS in 2013, he worked in Cigna’s
Emerging Markets segment and as president
and CEO of Scottsdale PHO, Inc.
DAVID BERRY, P. 146
General Partner
Flagship Ventures
David Berry holds an MD from Harvard Medical
School and a PhD from the Massachusetts
Institute of Technology. He was selected as
a 2014 Young Global Leader by the World
Economic Forum. In 2007, he was named
Innovator of the Year by the MIT Technology
Review, and one of the top thirty-five innovators
in the world under the age of thirty-five. He
speaks globally on topics such as innovation
and entrepreneurship.
BRENNAN TORREGROSSA, P. 12
VP and Associate General Counsel
GlaxoSmithKline
In December 1972, Brennan Torregrossa’s
mother, Ann, was nine months pregnant
with him when she and her lawyer husband
Joe won a voting rights case before the US
Supreme Court. Only the fifth woman to earn
a law degree from Villanova University, Ann
was nervous, and the baby started kicking
during oral arguments. Justice William Brennan
worried she might go into labor and helped
deflect another justice’s tough questions. He
later wrote the unanimous opinion in the case,
became a family friend, and in tribute, Ann
named her son after him.

Starting out as the interventional radiology
nurse manager at Balboa Naval Medical Center,
Jason Atkins has been active in the healthcare
industry since 2003, assuming various roles in
health informatics.

Simon Manoucherian immigrated to the United
States when he was five years old, and in fourth
grade decided to become a lawyer. After law
school, he specialized in litigation and made
partner at Meserve, Mumper & Hughes. Now, as
deputy general counsel of Grifols, Manoucherian
oversees the company’s entire legal function in
North America.

PEOPLE INDEX

HARVEY GUINDI, P. 170
Chief of Information Systems
Health Network Laboratories
With a passion for mobile technology and
healthcare, Harvey Guindi belong to the Drug
Information Association, New York Academy
of Sciences, and Institute of Electrical and
Electronics Engineers.
MICHAEL LYNCH, P. 98
Senior VP of Clinician Recruitment, Retention
Healthcare Partners
During his time working for the air force,
Michael Lynch earned the John Levitow
Award. Today, he leads Healthcare Partners
in enterprise efforts and strategy in clinician
recruitment and retention in addition to
academic partnerships and affiliations.
BOB HUDSON, P. 167
CFO
Henry Mayo Newhall Hospital

He holds a PhD in information systems with a
concentration in information security.
DAVID YOUNG, P. 126
Area Information Officer
Kaiser Permanente
David Young’s first exposure to computer
technology was during his six years in the air
force. Following the military, he was hired at
Kaiser Permanente, which allowed him enough
stability to finish his college education and earn
his MBA. Over the past twenty-one years, he
has held seven different positions at Kaiser
Permanente, each with increasing responsibility
and scope, and is currently area information
officer for San Bernardino.
LINDA WELLER-FERRIS, P. 27
VP
Lahey Health Cancer Institute

Bob Hudson has been with Henry Mayo
Newhall hospital for more than fifteen years.
He is also a board member of the California
Hospitals Association.

With a PhD from the University of Michigan,
Linda Weller-Ferris has more than eighteen
years of experience in senior oncology
leadership and multiple service lines, including
neurosciences, cardiovascular health,
women’s and children’s health, and robotic
surgery programs.

Raised on a “gentleman’s farm” near Ft.
Worth, Texas, Janice Klostermeier found
she had a proclivity for bookkeeping and
accounting in high school. In fact, she won
numerous speed contests for shorthand and
typing along the path that ultimately led her to
the C-suite of the healthcare industry.

Having previously served as the president and
CEO for the Renville County Hospital in Olivia,
Minnesota, Tim Rice has been the president
and CEO at Lakewood Health for more than
thirty-five years. He is active in the community
of Staples, Minnesota, as the chair of LEAP
Staples Area Business Group, a member of the
Staples Lions, and a member of the Staples
Area Men’s Chorus. In 2006, he received the
Staples Motley Citizen of the Year from the
Staples Motley Area Community Foundation.

JASON COOPER, P. 162
VP, Chief Analytics Officer
Horizon Blue Cross Blue Shield of New Jersey
Jason Cooper has more than twenty years of
experience in analytics and informatics in the
for-profit, nonprofit, and government sectors,
including leading teams at Horizon Blue
Cross Blue Shield, Cigna, and CVS Health.
He also belongs to the International Institute
for Analytics and the American Medical
Informatics Association, and is an editorial
board member at the American Journal of
Pharmacy Benefits.
JAMES BRADY, P. 126
Area Information Officer
Kaiser Permanente

Having begun her career as an RN, Gina Knox
brings a “practitioner’s perspective” to her role
as general counsel for Little Company of Mary
Hospital. An avid athlete and sports fan, she
“balances heart, mind, and soul” by training
regularly with long runs or weight training
before heading to work.
JERARD JENSEN, P. 96
General Counsel
Marshfield Clinic
A member of the Wisconsin State Bar, Jerard
Jensen is a Milwaukee native with more than
twenty-five years experience in healthcare law.

A leader in healthcare strategy, John O’Hearn
was awarded the Leadership Fellowship from
the Texas Hospital Association in 2015, followed
by a Health Care Transformation Fellowship
from American Hospital Association in 2016.
CLARK GOLESTANI, P. 130
Executive VP and CIO
Merck & Co., Inc.
Clark Golestani started his career in consulting
before getting exposed to biomedical
pharmaceuticals. He’s been with Merck since
1994 and holds a bachelor’s from MIT.
SHELLY HUNTER, P. 51
CFO
Mercy Hospital Joplin
Named one of the top leaders to know by
Becker’s Hospital Review in 2015, Shelly Hunter
is not only a healthcare leader, but she’s also
involved in her community. Currently, she is
on the board of the Joplin Family Y and Bright
Futures USA, a member of the Joplin Rotary, and
a volunteer ally for the Circles organization.
NICOLE HEIM, P. 103
CIO & VP
Milford Regional Medical Center
Nicole Heim has nearly twenty years of
experience in planning, supporting, managing,
and implementing healthcare information
systems.
DANA HUBBARD, P. 143
Head of Patents
MilliporeSigma
Aside from her role at EMD MilliporeSigma,
Dana Hubbard belongs to the American
Intellectual Property Law Association, Licensing
Executives Society, and Association of Former
Clerks and Technical Advisors to the US Court
of Appeals for the Federal Circuit, and the
Association of Corporate Patent Counsel.
LAURA ZEHM, P. 108
CFO
Montage Health
When Laura Zehm isn’t advancing Monterey’s
community health, she enjoys soaring the skies
in her Piper Archer plane. “I don’t actually care
where I am going,” she says. “The destination
is just a reason to get in the air.”
FRANK VENUTO, P. 79
Chief Human Capital Officer
Nebraska Medicine
It seems Frank Venuto was destined to work in
healthcare. Growing up in Rockville, Maryland,
he first spent time in a hospital as a young

AHLMAGAZINE.COM

James Brady spent two years in the navy
before he entered the nonprofit sector.
He worked his way from information
technology to healthcare and up to a CIO
role before a friend suggested he apply
for an area information officer position at
Kaiser Permanente. Brady was hired as area
information officer for Orange County in 2013.

GINA KNOX, P. 72
General Counsel
Little Company of Mary Hospital

JOHN O’HEARN, P. 24
VP of Strategy, Development
Medical Center Health System

175

PEOPLE INDEX

The Vitals continued
patient, and later worked as a lab aide during
high school. Though choosing healthcare
administration as his college major felt like a
natural transition, it wasn’t until he broke from
the industry to work for Marriott Corporation
that he developed his HR philosophy. While
he enjoyed his time in hospitality, Venuto says
he was soon drawn to healthcare once again.
“It was a combination of understanding the
mission of a hospital, which is to help people,
and the business side,” he says. “Being a part
of Nebraska Medicine is doing something better
than getting return on a stock.”
SHERYL BUSHMAN, P. 136
CMIO
Optimum Healthcare IT
Dr. Sheryl Bushman’s clinical background
gives her a unique perspective on medical
informatics. By implementing EHR systems,
she has helped transform healthcare delivery
in fifteen hospitals and hundreds of ambulatory
practices in six states. She lives on a working
farm outside of Kansas City, Missouri, raising
row crops, cattle, pigs, and chickens.
T.J. GRIFFIN, P. 60
Chief Pharmacy Officer
PharMerica

Bill Fenske has been in healthcare since he
joined Columbia Park Medical Group in 1989.
Today, he is the CFO at Rice Memorial Hospital
and serves as an adjunct professor at St. Mary’s
University and South Central College, where he
teaches in the accounting department.

Mark Johnson has essentially been with the
UnityPoint Health team since graduating from
Hillsdale College in 1987. His first job—one that
lasted twenty-four years—was for St. Luke’s
Regional Medical Center, an independent
hospital in Sioux City, Iowa, which affiliated
with UnityPoint. When not at work, Johnson is
a hockey aficionado who has been actively
involved in youth hockey for eighteen years,
serving on boards, coaching, and watching his
three sons play throughout the United States
and Canada.

MICHAEL HEDRICK, P. 111
CFO
Rogers Behavioral Health System
Before Rogers, Michael Hedrick advised on
growth and development strategy for banks and
large corporations; he has a successful record
of more than $13 billion in capital transactions
with more than thirty-five corporations.
However, Hedrick feels his three years of work
for Rogers is more significant than the entirety
of the previous twenty.
STEVE BURRES, P. 85
General Counsel
Rotech Healthcare, Inc.

T.J. Griffin has more than twenty years of
experience in pharmacy automation, and he
holds a bachelor of science from the University
of Iowa.
MEGAN MCKINNON, P. 93
Executive Director Compensation, Rewards
Piedmont Healthcare

Piedmont Healthcare’s Megan McKinnon has at
least one extraordinary childhood anecdote: at
age ten, she appeared in a scene with the late
Johnny Cash in the six-part television miniseries
The North and the South. She remembers a
long day of shooting, and that Cash, who
played the abolitionist John Brown, had trouble
with this lines.

Dr. Jack Cox first began to dream of a career in
medicine as a high school football player. His
mother, a nurse and his own family physician,
helped to inspire his interest in the medical field,
and his travels have taken him all over the world.

Kent Hoyos has been at the Pomona Valley
Hospital Medical Center for more than twenty
years. Today, he is directly responsible for IT
functions across the all departments.
DAVID SCHLAPPY, P. 22
VP & Chief Quality Officer
Reading Health System
AHL APR.MAY.JUN 2017

MARK JOHNSON, P. 87
Senior VP & CFO
UnityPoint Health

Having previously worked at a private law
firm, Steve Burres joined the medical world in
2014 as a member of the Rotech Healthcare
team. With both a bachelor’s degree and a law
degree from the University of Florida, Burres
is also a board member of Association of
Corporate Counsel.

KENT HOYOS, P. 34
CIO
Pomona Valley Hospital Medical Center

176

BILL FENSKE, P. 68
CFO
Rice Memorial Hospital

David Schlappy received his bachelor’s degree
in statistical science from BYU and a master’s in
biostatistics from UNC Chapel Hill. He worked as
a statistician for Intermountain Healthcare and
in the quality departments of four other hospitals
before joining Reading in 2014. He is a certified
Six Sigma Black Belt and speaks Korean.

TRENT TAHER, P. 18
Director of Health, Nutrition
Taher, Inc.
Trent Taher earned a degree in economics from
the University of Montana before he joined the
Taher, Inc. team in 2007. The company was
founded by Taher’s father, Bruce Taher, in 1981.
ADAM GOLD, P. 150
Director of Infrastructure Technology
UC Irvine Health
In 2013, Adam Gold won the Information
Services Blue Vase Award from UC Irvine, where
he has worked since 2008. Outside of work, he
is an active contributor to the American Society
for the Prevention of Cruelty to Animals.

JANET MILLER, P. 82
Chief Legal Officer & Corporate Secretary
University Hospitals
Janet Miller earned her bachelor’s degree from
the University of Michigan and her law degree
from the University of Notre Dame School of
Law. She has been with University Hospitals
for more than fifteen years while she has also
served on board of directors and governance
committee at the YWCA’s Cleveland Chapter.
GARY JOHNSON, P. 90
Chief Pharmacy Officer
University of Kentucky HealthCare
Gary Johnson’s interest in science initially
prompted him to consider becoming a
physician, but the desire for a routine schedule
that would leave room for raising a family led
him to pharmacy. As a former high school and
college basketball player, Johnson still plays
point guard in his local pick-up league. He
joined University of Kentucky HealthCare in 2011
after starting his career in pharmacy in 1997.
CAROL STELTENKAMP, P. 32
CMIO
University of Kentucky HealthCare
Carol Steltenkamp has been in the healthcare
industry for more than fifteen years. She holds
an MBA from the University of Kentucky and
an MD from University of Cincinnati College
of Medicine.
DAVID LUBARSKY, P. 138
Chief Medical, System Integration Officer
University of Miami Health System
David Lubarsky has been with the University
of Miami in one way or another for more
than fifteen years. Outside of his function of
chief medical, system integration officer, he
teaches in the schools of nursing, medicine,
and business. He is an active member of the
American Board of Anesthesiology and the
American Academy of Pain Management.

81%
Eighty-one percent of lawyers
believe that non-hourly billing
for outside counsel has become
a permanent trend. However, the
overall amount of work done on
a non-hourly basis has remained
steady for the past several years at
9 percent.
GLAXOSMITHKLINE, P.12

12%
AHL APR.MAY.JUN 2017

Blood Systems, Inc. delivers blood
products in twenty-four states and
provides about 12 percent of the
country’s blood supply. Through its
joint venture, Creative Testing Solutions,
it also tests roughly 35 percent of the
country’s blood supply.

178

BLOOD SYSTEMS, INC., P. 159

The long-term care industry serves
more than 13 million people in the United
States—a number that is projected to
double by 2050, a year when 20 percent
of the country will be older than 65.
BROOKDALE SENIOR LIVING, P.172

125
University Hospitals is one of the oldest
organizations in Cleveland, started by
a group of women to provide care for
those who couldn’t afford it—particularly
soldiers wounded in the Civil War and
workers injured during the Industrial
Revolution. Its children’s hospital is 125
years old, and its MacDonald Women’s
Hospital is the only hospital in Ohio
dedicated to women’s health.
UNIVERSITY HOSPITALS, P. 82

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